NewHampshireBreastandCervicalCancer

Program(BCCP)

NewHampshireDepartmentofHealthandHumanServicesDivisionofPublicHealthServices

BureauofPopulationHealthandCommunityServicesBreastandCervicalCancerProgram

29HazenDriveConcord,NH03301

Telephone:603.271.4931Fax:603.271.0539

Websites:www.getscreenednh.com

http://www.dhhs.nh.gov/dphs/cdpc/bccp/index.htm

Revised: June 2017

Policy and Procedure Manual

LETNO WOMAN BE OVERLOOKED• FREEBREASTANDCERVICALCANCERSCREENING

TABLEOFCONTENTS

Section1.ProgramOverviewProgramOverview ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐1

Section2.ProgramPoliciesClientConfidentiality‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐1

ClientEligibilityPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐2DataManagementPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐2EnrollmentforDiagnosticProcedure(s)Policy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐3ProgramReimbursementPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐4ReimbursementPoliciesforScreeningServices‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐5ReimbursementPoliciesforTransgenderClients‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐8ReimbursementPoliciesforDiagnosticServices‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐9MedicaidEnrollmentPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐13

MedicaidTreatmentActPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐14ClinicalRecordsPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐15RescreeningPolicy ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐15ResidencyPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐16TerminationPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐16LanguageInterpretationPolicy‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐16TransferofSiteCoordinator/CaseManager‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐17TobaccoScreeningandCessation‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐17

Section3.CaseManagement

CaseManager/SiteCoordinatorJobDescription‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐18PatientNavigation,CaseManagementandCommunityHealthWorkers‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐18

CaseManagementandEnrollment‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐20CaseManagementandNegativeFindings‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐20CaseManagementandShorttermFollow‐up‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐21CaseManagementandAbnormalResults‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐22

Section4.ClinicEducationandBilling

GuidelinesforClinicEducation‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐25CPTCodesandRates‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐25

Section5.PublicEducationandOutreach PublicEducationandProgramOutreach‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐25 OutreachIdeas‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐27Section8.OrderForms OrderForm:EducationalMaterials,IncentiveMaterialsandDataForms‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐28Appendices BCCPMailingAddressandContactInformation‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐29 BCCPStaffListing‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐30 AdditionalResources‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐31

Let No Woman Be Overlooked BREAST AND CERVICAL CANCER PROGRAM

MissionThemissionoftheNewHampshireLetNoWomanBeOverlookedBreastandCervicalCancer Program(BCCP)is“toplan,promote,andimplementprogramsofeducationandscreeningto reducemortalityratesthroughearlydetectionofbreastandcervicalcanceramongNew Hampshireclients.” HistoryandFunding NewHampshirehashadastate‐fundedBreastandCervicalCancerScreeningProgramsince 1985,whentheChronicDiseaseMortalityAssessmentandControlActwasestablished.In 1990,theU.S.CongresspassedtheBreastandCervicalCancerMortalityPreventionActof 1990,whichmandatedfundingfortheNationalBreastandCervicalCancerEarlyDetection Program. NewHampshirewasawardedacooperativeagreementfromtheCentersforDiseaseControl andPrevention(CDC)in1993forcapacitybuildinginthestate,andin1997wasawarded fundingforbreastandcervicalcancerscreening.Thisfundingdramaticallyincreasedthe capacityofthestatetoofferscreeningservicestolowincomeuninsuredclients,andtomonitor thequalityoftheprogram.

OnOctober24,2000,PresidentWilliamClintonsignedintolawtheBreastandCervicalCancer PreventionandTreatmentActof2000(PublicLaw106‐354).ThisActgivesstatestheoptionto providemedicalassistancethroughMedicaidtoeligibleclientswhowerescreenedforandfound tohavebreastorcervicalcancer,includingpre‐cancerousconditions,throughtheNationalBreast andCervicalCancerEarlyDetectionProgram(NBCCEDP).

StrategiesoftheBCCP SevenstrategiesareaddressedthroughtheBCCP:(1)Programcollaboration;(2)External partnerships;(3)Cancerdataandsurveillance;(4)Environmentalapproachesforsustainable cancercontrol;(5)Community‐clinicallinkagestoaidclientsupport;(6)Healthsystems changes;and(7)Programmonitoringandevaluation.

CLIENT CONFIDENTIALITY AllBCCPvendors,providersandcontractorsmusthaveawrittenpolicythatoutlinesmethodsto protecttheconfidentialityofclients.ConfidentialitymustbemaintainedforeachBCCPclient,in allaspectsoftheprogram.ThispolicymustbeincompliancewithHIPPAregulations.Allenvelopesandfaxescontaining clientidentifyinginformationmustbemarked“Confidential”beforesubmitting.Allelectroniccorrespondence(i.e.email)ofconfidentialinformationcontainingpersonal identifiersmustbetransferredand/orexchangedviaasecureelectronicsystem.

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BCCP - CLIENT ELIGIBILITY InordertobeeligibleforenrollmentintotheBCCP,aclientmustbe: overtheageof21

livingatorbelow250%ofpovertyaccordingtothefederalpovertyguidelines https://aspe.hhs.gov/poverty‐guidelineshttps://aspe.hhs.gov/poverty‐guidelines

uninsuredorhaveadeductibleorco‐payment

aNewHampshireresident(orYorkcounty,orborderingtownofMaine)

Ifaclientis65yearsorolder,theymustbeineligibleforMedicareornotenrolledinMedicare partB.Eligibilityfortheprogramwillbedeterminedatthescreeningsiteatthetimeofenrollment.

BCCPscreeningsitesshouldfollowtheiragency’spolicyregarding‘proofofincome.’TheBCCP stateofficedoesnotcollectbankingorwage/incomedocumentation.

EligibilityinBCCPisvalidfor12months.Allclientscanre‐enrollevery12months,provided theycontinuetomeettheeligibilitycriteria.

DATA MANAGEMENT InSeptember2016‐BCCPtransitionedfromthedatacollectionsystem“CaST”toaweb‐baseddatabasesystem“Med‐IT”–throughOxbowDataManagementSystems.

Med‐ITisasecureweb‐baseddatacollectionandbillingsystemthatfollowsHIPAAsafeguards.AlldatacollectedinMed‐ITisencryptedandisstoredonphysicalserverslocatedinasecure,highperformancedatacenter.

BCCPscreeningsitecoordinatorswillhavetheopportunitytoentertheirownclientdatadirectlyintoMed‐ITinthenearfuture.ThiswillreplacetheneedtoforwarddataformstotheStateBCCPofficeforcentraldataentry.Trainingaswellasastep‐by‐stepUser’sManualwillbemadeavailabletoallBCCPscreeningsitesfordataentry.Inthemeantime,thefollowingdataformsareREQUIREDtobesubmittedtotheStateBCCPofficeinatimelymanner–foreachBCCPclientenrolled:

EnrollmentForm(completedoneveryclient), InformedConsentForm(completedoneveryclient),*Thisistheonlyformthatdoes NOTneedtobeforwardedtothestateBCCPoffice.Acopyshouldstayattheclient’s screeningsiteandtheclientshouldalsobegivenacopyfortheirrecords.

ScreeningDataReportingForm(completedoneveryclient) CervicalCancerDiagnosticandTreatmentDataReportingForm(2pages)‐completed foreachclientreferredforfurtherproceduresasaresultofanabnormalPaptest.

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BreastCancerDiagnosticandTreatmentDataReportingForm(2pages)‐completedfor eachclientreferredforfurtherproceduresasaresultofanabnormalclinicalbreastexam ormammogram.

TheBCCPisrequiredbytheCDCtocollectspecifiedminimumdataelements(MDEs).Thisis datagatheredfromBCCPscreeningsitesandenteredintoMed‐ITincluding:enrollment, screeninganddiagnostics.MDEsaresubmittedwithoutanypersonalidentifierstoCDCtwice peryear(April15th,October15th).TheBCCP’sfederalfundingfromCDCiscontingentupon successfulsubmissionofMDEsaswellasmeetingspecifiedCoreProgramPerformance Indicatorswhichinclude: InitialProgramPapTests;RarelyorNeverScreened(20%) MammogramsProvidedtoClients50YearsofAge(75%) AbnormalCervicalCancerScreeningResultswithCompleteFollow‐Up(90%) AbnormalCervicalCancerScreeningResults;TimefromScreeningtoDiagnosis>90Days(≤25%) TreatmentStartedforDiagnosisofHSIL,CIN2,CIN3,CIS,Invasive(90%) HSIL,CIN2,CIN3,CIS;TimefromDiagnosistoTreatment>90days(≤20%) InvasiveCervicalCarcinoma;TimefromDiagnosistoTreatment>60days(≤20%) AbnormalBreastCancerScreeningResultswithCompleteFollow‐Up(90%) AbnormalBreastCancerScreeningResults;TimefromScreeningtoDiagnosis>60days(≤25%) TreatmentstartedforBreastCancer(90%) BreastCancer;TimefromDiagnosistoTreatment>60days(≤20%)DueDatesforBCCPScreeningSitestoSubmitDatatotheStateBCCPOffice: EnrollmentFormdatamustbesubmittedtothestateofficeoftheBCCPwithinoneweek

ofthescreeningappointment,andthesignedInformedConsentFormisfiledintheclient’srecord.Theinformedconsentformmustbesignedbyanagencystaffmember,verifyingtheclientunderstandstheconsentform.

ScreeningDataReportingFormswillbecompletedbythecasemanagerandsubmittedtotheBCCPwithinoneweekofreceivingthescreeningresults.

EachDiagnosticandTreatmentDataReportingFormwillbecompletedbythecasemanagerandforwardedtotheBCCPwithinoneweekofdeterminingthefinaldisposition.

NoClaimcanbepaidthroughtheBCCPuntilthecorrespondingdataisreceivedbytheBCCPscreeningsite.ClaimsareoftentimesforwardedtotheStateBCCPofficeforpaymentwithin

aweekortwooftheprocedurebeingperformed.

ENROLLING CLIENTS FOR DIAGNOSTIC TESTING ONLY

ClientsmaybeenrolledintheBCCPfordiagnostictestingonly,if: theyhaveasymptom(eitherfoundbythemselvesorbyaprovider,andtheywerenot enrolledinBCCPatthetime).OR… theyreceiveanabnormalscreeningtestthatisnotfundedbytheBCCPandtheyrequire additionalfollow‐up.

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Clientsenrolledfordiagnosticproceduresmuststillmeetalleligibilityrequirements,andall correspondingdatamustalsobecollectedontheclient.Documentingabnormalfindingsfrom previousscreeningsisespeciallyhelpfulandwouldbemarkedas“unfunded”intheMed‐IT database. Casemanagementofallclientsenrolledfordiagnosticprocedures,throughdefinitivediagnosis andtreatment,mustbecarriedoutbythecasemanagerorsitecoordinator.Followupand trackingmustalsotakeplace.

PROGRAM REIMBURSEMENT POLICY TheBCCPwillreimburseforspecifiedservicesatanegotiatedrate,nottoexceedthefederalMedicareCPT(currentproceduralterminology)codescheduleforreimbursement,basedonavailabilityoffunding.

Onlyservicesforeligibleclientscanbebilled. Thedatamanageratthestateofficewillverify:

o theclientisenrolledintheprogram,o validacceptedCPTcodeshavebeenused,o correspondingdatahasbeenreceivedbytheStateBCCPoffice,ando theaccuracyofthefeesforservices.

ApprovedbillswillbeforwardedtoStateofNH,Dept.ofHealthandHumanServices,AccountsPayable.DisallowedbillswillbereturnedtotheVendor.

TheProviderorFacilityagreestoacceptclientsreferredbytheBreast&CervicalCancer Programfor: AnesthesiaservicesEvaluation/managementservicesPathology/Laboratoryservices RadiologicalservicesSurgicalservicesClaimsmustbesubmittedtotheBreast&CervicalCancerProgramStateOfficewithin90dayof thedateofserviceonaCMS‐1500formoraUB‐04form.Anyclaimsreceivedthatare90days orolderfromthedateofservicewillbedenied.Aclaimdeniedforbeinguntimelymaynotbe billedtotheclient.AnExplanationofBenefits(EOB)mustbesubmittedforBreast&CervicalCancerProgram clientswhoalsohaveotherinsurance.TheBreast&CervicalCancerProgramispayeroflast resort.TheProviderorFacilityagreesnottobillclientsoftheBreast&CervicalCancerProgramforthe differentialchargesbetweentheBreast&CervicalCancerProgram’sfeescheduleandtheusual charges.TheProviderorFacilityagreestomaintaincurrentrequiredlicenses,certificationsorother documentationasrequiredbyapplicablestateandfederallawswhichallowthisprovideror facilitytoprovideservices.

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TheProviderorFacilityacknowledgesthatsuspensionorterminationfromparticipationinthe DivisionofPublicHealthServices’Breast&CervicalCancerProgramwillresultifconvictedofa criminaloffenseundertheMedicareorMedicaidProgram,oriftheNewHampshireDepartment ofHealthandHumanServiceshasadministrativelydeterminedthatfraudexists.TheProviderorFacilityisconsideredenrolled,withtheunderstandingthattheymaycancel participationinthisprogramwitha30daywrittennoticetotheBreast&CervicalCancer Program.IftherearechangestoanyProviderorFacilitiescontactoraddressinformation,pleaseemail updatedinformationatkristen.gaudreau@dhhs.nh.gov.

REIMBURSEMENT POLICIES FOR SCREENING SERVICES InDecember2009,theUnitedStatesPreventiveServicesTaskForce(USPSTF)updateditsbreastcancerscreeningrecommendationsbasedonmorerecentsystematicreviewsofthescientificliterature.Basedonthoserecommendations,theNHBCCPhasinplace,thefollowingprogrampaymentguidelinesforbreastcancerscreeningasfollows: BreastCancerScreeningforClientsAge50to74yearsBCCPfundsmaybeusedtoreimbursescreeningmammographyeveryonetotwoyearsfor clientsinthisagegroup.Aminimumof75%ofallBCCPmammogramsshouldbeprovidedtoprogram‐eligibleclients whoare50yearsofageandolderandnotenrolledinMedicarePartB.BreastCancerScreeningforClientsAge40to49yearsThedecisiontostartregular,screeningmammographybeforetheageof50yearsshouldbean individualoneandtakeclientcontextintoaccount,includingtheclient’svaluesregardingspecific benefitsandharms.BCCPfundsmaybeusedtoreimbursescreeningmammographyinthisagegroup,ifthedecision toscreenhasbeenreachedbetweenaclientandtheirhealthcareprovider.Mammogramsprovidedtoprogram‐eligibleclientslessthan50yearsofageshouldNOTexceed 25%ofallmammogramsprovidedbytheBCCP.BreastCancerScreeningforClientsunderAge40yearsRegularmammographyscreeningisNOTrecommendedinclientsunderage40yearsand thereforewillnotbereimbursedthroughtheBCCP. Symptomaticclientsundertheageof40–BCCPfundscanbeusedtoreimburseCBEsfor clientsundertheageof40.IfthefindingsoftheCBEareconsideredtobeabnormal,including adiscretemass,nippledischarge,andskinornipplechanges,aclientcanbeprovideda diagnosticmammogramorultrasoundbytheprogramand/orreferredforasurgical consultation.

BreastHealthScreeningServices

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o Ifanabnormalfindingorsymptomisdiscoveredbyaclient,areferralcanbeprovidedbytheBCCPforadiagnosticmammogram,ultrasoundorasurgicalconsultation.

BreastTomosynthesis(3‐DMammography)CDCbeganauthorizingthereimbursementofBreastTomosynthesisinDecember2016.Dense breastscanmakeitharderformammogramstodetectbreastcancer.Studiesshowthatadding 3‐Dmammogrophytoregularscreeningmammogramscandetectmorecancersindensebreasts.Whiletheadditionof3‐Dmammographymayimprovethesensitivityfordetectingcancerin densebreasts,itmightalsoincreasethenumberof“false‐positive”screeningmammogramsin someclients.Clientsshouldbeeducatedastotherisksandbenefitsofchoosingtohaveeithera 2‐Dor3‐Dscreeningmammogramperformed.BreastScreeningMRITheBCCPmayreimburseforSCREENINGbreastMRIperformedinconjunctionwitha mammogramwhen: AclienthasaBRCAmutation* Aclienthasafirst‐degreerelativewhoisaBRCAcarrier,or

Aclienthasalifetimeriskof20‐25%orgreaterasdefinedbyriskassessmentmodelssuchasBRCAPROthatarelargelydependentonfamilyhistory.

BreastMRIcanalsobereimbursedwhenusedtobetterassessareasofconcernonamammogram or for evaluation of a client with a past history of breast cancer after completing treatment. BreastMRIshouldneverbedonealoneasabreastcancerscreeningtool.BreastMRIcannotbereimbursedforbytheBCCPtoassesstheextentofdiseaseinclientswho havealreadybeendiagnosedwithbreastcancer. Providersshoulddiscussrisk factorswithall clientstodetermine if theyareathighrisk forbreastcancer. Tobemosteffective, it iscritical thatbreastMRI isdoneat facilitieswithdedicatedbreastMRIequipmentandthatcanperform MRI‐guidedbreastbiopsies.*BRCAgenetictestingiscurrentlyNOTreimbursedforthroughBCCP.Clientsmustmeetcertainhighriskcriteriabeforethey'reconsideredforBRCAtesting.IfclientsmeethighriskcriteriaandhavehealthinsurancethroughtheMarketplace‐BRCAtestingisconsideredaPreventiveHealthServiceforclientsandthereforeplansmustcoverthetestingforclientswithoutchargingacopaymentorcoinsurance.

*Priortosubmittingforreimbursement,screeningbreastMRIshouldfirstbeapprovedbythestateBCCPpublichealthnurse

InMarch2012,theUnitedStatesPreventiveServicesTaskForce(USPSTF)updateditscervicalcancerscreeningrecommendationsbasedonmorerecentsystematicreviewsofthescientificliterature.Basedonthoserecommendations,theNHBCCPhasinplace,thefollowingprogrampaymentguidelinesforcervicalcancerscreeningasfollows:

CervicalHealthScreeningServices

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CervicalCancerScreeningforClientsage21to29yearsofageScreeningforcervicalcancerinclientsage21to29yearswithcytology(Paptest)every3years.CervicalCancerScreeningforClientsage30to65yearsofage Forclientswhowanttolengthenthescreeninginterval,acombinationofcytology(Paptest)and humanpapillomavirus(HPV)testingevery5years.CervicalCancerScreeningforClientsundertheageof21yearsUSPSTFrecommendsAGAINSTscreeningforcervicalcancerinclientsyoungerthan21yearsof age,neitherwithcytology(Paptest)alone,norwithHPVtestingincombinationwithcytology.CervicalCancerScreeninginClientswhohaveaHistoryof(pre)CanceroftheCervixClientswhohavehadahistoryof(orhysterectomyfor)CINdiseaseshouldundergocervical cancerscreeningfor20yearsevenifitgoespasttheageof65years.Clientswhohavehad cervicalcancershouldcontinuescreeningindefinitelyaslongastheyareinreasonablehealth. Theexactintervalsofthisscreeningarenotclear,buttherecommendationsdefineitas“every3 yearsafteraperiodofintensescreening.”CervicalCancerScreeninginClientswhohavehadahysterectomyNOTrelatedtoaCancerUSPSTFrecommendsAGAINSTscreeningforcervicalcancerinclientswhohavehada hysterectomywithremovalofthecervixandwhodoNOThaveahistoryofahigh‐grade precancerouslesion(cervicalintraepithelialneoplasia[CIN]grade2or3)orcervicalcancer.HPVtestingaloneUSPSTFrecommendsAGAINSTscreeningforcervicalcancerwithHPVtestingaloneforanyage.CervicalCancerScreeninginClientsolderthanAge65years.USPSTFrecommendsAGAINSTscreeningforcervicalcanceramongclientsolderthanage65 yearswhohavehadadequatescreeningandarenothighrisk.CervicalCancerScreeninginClientswhoareHighRiskClientswhoareconsideredhighrisk(i.e.HIVpositive,immunocompromised,andexposedin uterotodiethylstilbestrol‘DES’)shouldundergoannualtesting.IncreasingScreeningforBCCP‐eligibleClientsNeverorRarelyScreened20%ofallclientsnewlyenrolledforcervicalcancerscreeningshouldbeclientswhohave neverbeenscreenedforcervicalcancerorwhohavenotbeenscreenedforcervicalcancer withinthepast5years.Genotyping(i.e.CervistaHPV16/18)ThestandardHPVtestonlytellsifaclienthasanHPVinfection,notwhichtypeortypesofHPV arecausingtheinfection.AnHPVgenotypingtestcanidentifythespecificHPVtype,notjusttest forthepresenceofanytype.LiketheHPVtest,thistestisoftentakenfromthesamesampleasthePaptestorbyanadditional swabofthecervixatthetimeofthePaptest.ItisknownthatinfectionwithHPV16orHPV18 carryahigherriskofcausingcancerthaninfectionswithotherHPVtypes.Ifawoman30yearsofageorolder,hasanormalPaptestandapositiveHPVtest,genotypingcan helpdecide:

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IfHPV16or18arepositive–aclientneedsfurther,immediatetesting(colposcopy). IfHPV16or18arenegative–aclientcanwaitandrepeatco‐testingin1year. Ifaclientreceivesanabnormalscreeningtestresultatanytime,policiesforfollow‐upofabnormalcervicalcancerscreeningtestsandreimbursementofdiagnosticprocedures

shouldbefollowed.

TRANSGENDER CLIENTS (MALE-TO-FEMALE) SCREENING POLICY TheBCCPmay reimburse for screening anddiagnostic services for transgender clients (male‐to‐female): Whohavetakenoraretakinghormonesand, Meetallotherprogrameligibilityrequirements Althoughtherearelimiteddataregardingtheriskforbreastcanceramongtransgenderclients, evidencehasshownthatlongtermhormoneusedoesincreasetheriskforbreastcanceramong clientswhosebiologicalsexwasfemaleatbirth. WhileCDCdoesnotmakeanyrecommendationaboutroutinescreeningamongthispopulation, transgenderclientsarethuseligibleunderfederallawtoreceiveappropriatecancerscreening. CDCrecommendsthatgranteesandproviderscounselalleligibleclients,includingtransgender clients,aboutthebenefitsandharmsofscreeninganddiscussindividualriskfactorsto determineifscreeningismedicallyindicated. TheCenterofExcellenceforTransgenderHealthandtheWorldProfessionalAssociationfor TransgenderHealthhavedevelopedconsensusrecommendationsonpreventivecareservicesfor thetransgenderpopulation.Thoserecommendationsincludefor: “transclientswithpastorcurrenthormoneuse,breast‐screeningmammographyinclients overage50withadditionalriskfactors(i.e.estrogenandprogestinuse>5years,positive familyhistory,FMI>35).”Thosepreventivecarerecommendationscanbefoundat: http://transhealth.ucsf.edu/trans?page=protocol‐screening#S2X.

TRANSGENDER CLIENTS (FEMALE-TO-MALE)

Clientsthatwerebornfemale,butwhohavetransitionedoraretransitioningtomaleshouldstill continuetogetscreenedaslongastheyhavebreastsandacervix.AllTransgenderClientsshouldcontinuetofeelwelcomeintheBCCPandsensitivity

andrespectfordeliveringoptimalhealthcareservicesshouldbefollowed.

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REIMBURSEMENT POLICIES FOR DIAGNOSTIC SERVICES AdequacyofFollow‐upforClientswithAbnormalScreeningResultsAclientwhosebreastorcervicalcancerscreeningwasabnormalorsuspiciousmustreceive appropriatediagnosticprocedures.Aclientwithadiagnosisofbreastorcervicalcancermustbereferredforappropriatetreatment.TimelinessofFollow‐upforClientswithAbnormalScreeningResultsTheintervalbetweeninitialscreeninganddiagnosisofabnormalbreastcancerscreening shouldbe60daysorless.Theintervalbetweeninitialscreeninganddiagnosisofabnormalcervicalcancerscreening shouldbe60daysorless.Theintervalbetweendiagnosisandinitiationoftreatmentforbreastcancerandinvasive cervicalcancershouldbe60daysorless.Theintervalbetweendiagnosisandinitiationoftreatmentforcervicalintraepithelial neoplasia(CIN)shouldbe90daysorless.CaseManagementAllBCCP‐enrolledclientswithanabnormalscreeningresultmustbeassessedfortheirneed ofcasemanagementservicesandprovidedwithsuchservicesaccordingly.Examplesofscreeningresultswhichwouldrequireacasemanagementassessmentwouldbe BIRADS3,4,or5formammograms;andASC‐US,LSIL,andhighlesionsforPaptests.Casemanagementservicesconcludewhenaclientinitiatestreatment,refusestreatment,orisno longereligiblefortheBCCP.Whenaclientconcludescancertreatment,hasbeenreleasedbyatreatingphysiciantoreturntoa scheduleofroutinescreeningandcontinuestomeetBCCPeligibilityrequirements,theclientmay returntotheprogramandreceiveBCCPservices. UltrasoundUltrasoundhasanumberofusesinthediagnosticworkupforbreastcancer.Thetraditionalrole ofultrasoundistodistinguishbetweencysticandsolidmasses.Ultrasoundplaysanimportant roleindeterminingwhetheramassisbenignornot.

Ultrasound‐guidedcystaspirationisaprocedurethatcanbeperformedwhenacystic‐looking lesioncannotbeconfidentlydiagnosedasasimplecystonthebasisofitssonographic appearance,orwheneithertheclientorproviderdesireaspiration.

Follow-up and Abnormal Screening Results

BreastCancerDiagnosticServices

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Ultrasoundcanguideinterventionalbreastprocedures,including:FNA,coreneedlebiopsy, andneedlelocalizationforsurgicalbiopsy. DiagnosticMammographyDiagnosticmammographyusuallyisconductedbecauseaclienthasaspecificcomplaint(i.e. symptoms)orspecificclinicalfindings.Filmsarereadbytheradiologistimmediatelytoallowfor furthertesting.Thistypeofmammographydiffersfromscreeningmammography,whichis performedintheabsenceofsymptomsorotherclinicalindicators.Inaddition,moretimewill elapsebeforefilmsarereadforscreeningmammography.DiagnosticBreastMRIDiagnosticbreastMRImaybepermissibleforreimbursementthroughBCCPMedicaidifaclientis eligible.TheroleofMRIholdspromiseindifferentiatingtumorfromscartissueandfibrocystic changes.WhenMRIisrecommendedfordiagnosticpurposes,aclientmustfirstseeabreast specialist/breastsurgeonforreferral.IfadiagnosticMRIisordered,theclientmustthenbe enrolledunderBCCPMedicaidPresumptive(ifeligible).BCCPscreeningsitecoordinators/case managerswillworkwiththeStatePublicHealthNursethroughoutthisprocess.Computer‐AidedDetection(CAD)CADcanaidmammographersasanimpartial“secondreader”forselectmammograms.Thistechnologyindicateschangesonamammogramthatmayneedextraevaluationbytheradiologist.Itdoesnotdiagnose,butitlooksforsubtlechangesontheimages.Thecomputerhighlightsthesuspiciousareasonamonitor.SincethecurrentscientificevidenceisinsufficienttodemonstratethattheuseofCADreducesmorbidityandmortalityassociatedwiththedetectionofbreastcancer,BCCPdoesNOTprovidereimbursementforthisserviceasanindividualCPTcode.

ComputerizedTomography(CT)–CThasNOpracticalroleintheevaluationofthebreast, althoughinrareinstancesitcanbehelpfulinlocalizinglesionsforbiopsy.Theroleofbreast scintigraphyandpositronemissiontomographyasadjunctstomammographyareyettobe determined;hencenoneoftheseproceduresareusedroutinelyinpracticeandarenot reimbursedbyBCCP.

BreastBiopsy Fine‐NeedleAspiration(FNA)–FNAcansafelyandreliablydiagnoseabreastmassasa benignsimplecyst(fluidfilled)ifthemasscompletelyresolvesafteraspirationandaspirated fluidisbenigninappearance(i.e.,notclear,gelatinous,orgrosslybloody).FNAofsolidbreast massesisavaluablediagnostictoolwhendonebyexpertsandinterpretedbyexperienced cytopathologists.

Large‐CoreNeedleBiopsy(LCNB)–LCNBofthebreastprovidesacoreoftissueforhistologic evaluation.Whenproperlydone,itisasafe,well‐tolerated,andcost‐effectivealternativeto surgicalbiopsy.LCNBspecimenscanbeinterpretedbyapathologistandcanyieldspecific histologicaldiagnoses.Whenamassispalpable,thiskindofbiopsyissometimesdonebya surgeon.

Anonpalpablemassdetectedthroughscreeningmammographycanbebiopsiedbyaradiologistusingultrasoundormammographic(stereotactic)guidance.

Corebiopsyisasamplingtechniqueandisnotintendedtoremovethelesion(withthepossibleexceptionofMammotomebiopsy).Thishistologicresultmustexplainorbeconsistentwiththeimagingfindings–otherwise,anotherbiopsyand/orreadingofthepathologyismandatory.

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OpenSurgicalBiopsy–Surgicalremovalofabreastlesionisperformedfordominant(i.e. definedborders)palpablemasses.Surgicalbiopsyalsomaybeusedwithnonpalpable screening‐detectedlesions;however,LCNBisbeingusedmorefrequentlyintheevaluationof theselesions.Needle‐localizedsurgicalbiopsyfornonpalpablebreastlesionsalsocanbeused; thismethodhasa2%to3%errorrate,whichissimilartothesamplingerrorofLCNB.

Diagnosticproceduresperformedatafacility(andincurringfacilitycharges)rather thaninaproviderofficecanNOTbecoveredbytheBCCP,butrathertheclientshouldbe

enrolledunderBCCPMedicaidPresumptive,ifeligible.

ManagingClientswithAbnormalCervicalCancerScreeningResultsToarriveatadefinitivediagnosisforaclientwithanabnormalcervicalcancerscreeningtest,the BCCPwillreimbursecolposcopy,colposcopy‐directedbiopsy,endocervicalcurettage,andinrare cases,diagnosticexcisionalprocedures(suchasLEEPandcold‐knifeexcisions),aswellas associatedpathology.ReimbursementofHPVDNATestingHPVDNAtestingisareimbursableprocedureifitisusedinfollow‐upofanASC‐USresultfrom thescreeningexamination,orforsurveillanceat1yearfollowinganLSILPaptestwithout evidenceofCINoncolposcopy‐directedbiopsy. ColposcopyAcolposcopyistheexaminationofthecervix,vagina,andinsomeinstances,thevulvawithalow‐ poweroperatingmicroscope(colposcope)aftertheapplicationofa3%to5%aceticacidsolution (vinegar).Thisprocedureisusuallycoupledwithcervicalbiopsyandendocervicalsamplingtoobtain specimensforhistologicalevaluation,usingbiopsyforcepsandanendocervicalcurette,orfor cytologicalevaluationoftheendocervix,usingacytobrush.

SatisfactoryColposcopy–Satisfactorycolposcopyindicatesthattheentiresquamocolumnar junctionandthemarginofanyvisiblelesioncanbeseenwithacolposcope. Whennolesionoronlybiopsy‐confirmedCIN1isidentifiedaftersatisfactorycolposcopyin clientswithHSILPaptestreports,areviewofthecytology,colposcopy,andhistologyresults shouldbeperformed,whenpossible. Ifthereviewyieldsarevisedinterpretation,providersshouldfollowguidelinesfortherevised interpretation;ifacytologicalinterpretationofHSILisupheldorifreviewisnotpossible,a diagnosticexcisionalprocedure(e.g.LEEP)ispreferredinnonpregnantclients. Acolposcopicreevaluationwithendocervicalassessmentisacceptableinspecial circumstances,suchaswhenCIN2orCIN3isnotfoundinayoungclientofreproductiveageor duringpregnancywheninvasivecancerisnotsuspected.

UnsatisfactoryColposcopy–Whennolesionisidentifiedafterunsatisfactorycolposcopyin clientswithHSIL,areviewofthecytology,colposcopy,andhistologyresultsisperformed.If

CervicalCancerDiagnosticServices

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thereviewyieldsarevisedinterpretation,providersshouldfollowguidelinesfortherevised interpretation. IfcytologicalinterpretationofHSILisupheld,reviewisnotpossible,orbiopsy‐confirmedCIN1 isidentified,adiagnosticexcisionalprocedureisrecommendedinnonpregnantclients. Ablationisunacceptable.Duringpregnancy,ifinitialcolposcopyisunsatisfactory,itmay becomesatisfactorylaterinpregnancyandsoshouldberepeatedwithin6to12weeks. Althoughclientmanagementprotocolsarewelldefinedfornormalandabnormalpaptests,the follow‐upofanASC‐USreportismorechallenging.Inthemedicalcommunity,theASC‐US categoryisknownasan“Idon’tknow”categorybecausethelaboratoryisunsureaboutthe statusofthePaptest.Often,clientswhoreceiveanASC‐USresultaretreatedasiftheyhavean abnormalPaptest,eventhoughonlyanestimated25%to35%oftheseclientsactuallyhave cervicaldisease. Omissionofendocervicalsamplingisacceptablewhenadiagnosticexcisionalprocedureis planned.InclientswithHSILinwhomcolposcopysuggestsahigh‐gradelesion,initial evaluationusingadiagnosticexcisionalprocedureisalsoanacceptableoption.Triageusing eitheraprogramofrepeatcytologicaltestingorHPVDNAtestingisunacceptable. PapandColposcopySameDateofServiceThereisonlyonescenariowhereBCCPfundscanbeusedtoreimburseforaPapandcolposcopy samedateofservice(dos).IfaclientisundermanagementforHSIL,whennoCIN2or3is identified,thePapandcolposcopyaredoneatthesametimetoprovidecytologicaland histologicalresultsatthe6monthinterval.Whencolposcopyisperformedasimmediate diagnosticfollow‐uptoanabnormalPap(performedroutinelywithoutapriorhistoryof abnormalities),aPaptestperformedatthetimeofcolposcopyisnotneededandmaynotbe reimbursed.IfthePaptestresultatthe6monthintervalPapandcolposcopyappointmentis HSIL,adiagnosticexcisionalprocedureisrecommended.

HPVTestingforDiagnosticPurposes BCCPscreeningsitesshould“reflexHPVtesting"asafollow‐uptoASC‐USPaptestresultsfor ALLclients,regardlessofage.Byutilizingresidualcellsfromtheliquid‐basedPaptestvialto testforthepresenceorabsenceofhigh‐riskHPV,isanefficientcost‐effectiveprocessto determineaclient’shigh‐riskHPVDNAstatus.Thefindingofhigh‐risktypesofHPVDNAinacervicalspecimenfromaclientwithanASC‐USPap testsuggeststhepresenceofLSILratherthanabenignreactiveprocess.Thesehigh‐riskclients shouldgoontocolposcopyandbiopsy/treatmentifindicated.

HPVtestingisareimbursableprocedureforallclientsifitisusedinthefollow‐upofanASC‐US resultfromthescreeningexamination,orforsurveillanceofanLSILtestwithabnormal colposcopyatthenextannualexamination.

LEEP,LaserConization,andCold‐KnifeConization(Cone)TheseinvasivediagnosticproceduresareapprovedforthemanagementofclientswithHSIL, CIN1,CIN2,CIN3,orinvasivecervicalcarcinoma.InMOSTsituations,LEEPandConeareconsideredtreatmentandwouldbecoveredunder

BCCPMedicaidPresumptive,ifaclientisdeemedeligible.

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EndometrialBiopsy(EMB)EMBusesasoftplastictubewithacentralplungerthatformsavacuumtoremovethecellslining theinsideoftheuterus.Pathologyevaluationisusedtolookforchangesindicatingendometrial (uterine)cancerorprecursorendometrialhyperplasia.EMBisindicatedwheneverthePaptest showsAGC(atypicalglandularcells)andinapost‐menopausalclientwithotherriskfactors(i.e. abnormalbleeding,endometrialcells),inordertoruleoutanytypeofendocervicalcomponent.If EMBresultsrevealauterineorendometrialconcernandnocervicalinvolvement,BCCPfunds cannotbeusedtocontinueadditionaltesting. CervicalPolypRemovalThechancethatacervicalpolypiscancerousisquitesmall(<1%),however,allcervicalpolyps shouldberemovedandsentforpathology.Theprovidershouldremovethepolypduringan officevisit.Thisisgenerallyaverysimpleprocedure,performedintheofficesettingatno additionalcost.Veryrarely,itmaybeappropriatetoreferaclienttoanOB/GYNforremoval. BCCPcoverstheofficevisittoremovethepolyporthegynecologyconsultifthepolyprequires removalfromanOB/GYN.BCCPalsocoversthepathologyofthepolyp.

MEDICAID ENROLLMENT

Clientswhohavebeenscreenedand/ordiagnosedthroughaBCCPproviderandfoundtoneed treatmentforbreastorcervicalcancer(orpre‐cancerousconditions)areeligiblefortreatment undertheBreastandCervicalCancerPreventionandTreatmentActof2000(BCCPTA)aslongas theymeetcertainMedicaidcriteria:

havenootherhealthinsurance, bearesidentofNewHampshire, beaU.S.citizenORhaveagreencardandhavebeenintheU.S.foratleast5yearsorbe

consideredasasylee. AclientmustalsobecurrentlyenrolledintheBCCP,havereceivedatleastonescreeningordiagnosticservicethroughBCCP,beenfoundtoneedtreatmentforeitherbreastorcervicalcancer(includingpre‐cancerousconditions),andbe64yearsofageoryounger.

EnrollmentintoBCCPMedicaidisfacilitatedbetweentheBCCPsitecoordinator/casemanager andtheStateBCCPofficePublicHealthNurse.ThePublicHealthNurseworksdirectlywiththe Medicaidofficetoenrolleligibleclients.RequiredBCCPMedicaidapplicationformsinclude:MedicaidForm369a(MedicalAssistanceEnrollmentform);MedicaidForm369b(AssistedApplicationforHelpwithMedicalCosts);770EstateRecoveryForm,andNeedofTreatmentorPhysician’sEstimate.

BCCPsitecoordinatorswillworkdirectlywithclientstocompleteaboveapplicationpaperwork.AllrequiredformsshouldbeassembledbythesitecoordinatorandfaxedtotheNHBCCPstateoffice(271‐0539)assoonascompleted.

BCCPstaffwillconfirmBCCPenrollmentandneedfortreatment.

Onceeligibilityhasbeenverified,theStateBCCPPublicHealthNursewillcontacttherespectiveBCCPsitecoordinator/casemanager,providingdetailsonenrollmentandMID#.

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TheMedicaidofficewillpostalmailadditionalinformationtotheclientregardingcoverageaswellasaMedicaidIdentificationCard.

AllclientsenrolledinBCCPMedicaidwillberequiredtochooseaCareManagementplanwithin60daysofBCCPMedicaidenrollment.Ifaclientdoesnotchooseaplan,Medicaidwillauto‐assignone.AdditionalinformationoncaremanagementplanswillbepostalmaileddirectlytotheclientfromtheOfficeofMedicaid.

PriortochoosingaCareManagementPlan–theBCCPMedicaidclientshouldassurethatthespecialiststheywouldliketoseeforcarearepartoftheCareManagementPlan’sNetworkofproviders.TheBCCPsitecoordinatorcanassistwiththisprocessaswell.

OnceaclientisenrolledinBCCPMedicaid–theybecomeinactiveintheBCCPuntildischargedfromtreatmentorisnolongereligibletoreceiveMedicaid.

60daysbeforethecourseoftreatmentiscomingtoanend,theStateBCCPPublicHealthNursewillcontacteachrespectivesitecoordinator,lettingthemknowofupcomingBCCPMedicaidrenewals.

BCCPsitecoordinators/casemanagersareresponsibleforcontactingandworkingwithBCCPMedicaidclientstocompleterenewalpaperworkor,iftreatmenthasendedornolongereligibleforMedicaid–sharingthisinformationwiththeStateBCCPPublicHealthNurseinatimelymanner.

ACA/HealthInsuranceandTreatmentNeedsIfaclienthasprivatehealthinsurance(evenwithahighdeductible)andisdiagnosedwithbreast orcervical(pre)cancer–theyCANNOTbeenrolledintoBCCPMedicaidunlesstheirprivatehealth insuranceends.Iftheirprivatehealthinsuranceendsandtheyhavebeendiagnosed,thereisnowaitingperiodto enrollintoBCCPMedicaidif: AllotherBCCPeligibilitycriteriahasbeenmet TheclientwasdiagnosedthroughoneofBCCP’svendorfacilities Theclientwasveryrecentlydiagnosed;and TheclienthasatleastonepaidBCCPservice

MEDICAID TREATMENT ACT ABOUTTHEACTOnOctober24TH,2000,PresidentWilliamClintonsignedintolawtheBreastandCervicalCancer PreventionandTreatmentActof2000.

ThisActgivesstatestheoptiontoprovidemedicalassistancethroughMedicaidtoeligible clientswhowerescreenedforandfoundtohavebreastorcervicalcancer,including precancerousconditions,throughtheNationalBreastandCervicalCancerEarlyDetection Program

OnJanuary15TH,2002,PresidentBushsignedtheNativeAmericanBreastandCervicalCancer TreatmentTechnicalAmendmentActof2001.

ThisbillamendstitleXIXoftheSocialSecurityActtoclarifythatIndianclientswithbreastor cervicalcancerwhoareeligibleforhealthservicesprovidedunderamedicalcareprogramofthe IndianHealthServiceorofatribalorganizationareincludedintheoptionalMedicaideligibility

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categoryofbreastorcervicalcancerclientsaddedbytheBreastandCervicalCancerPrevention andTreatmentActof2000.

CLINICAL RECORDS

AllclinicalrecordsforclientsenrolledintheBCCPwillbeintegratedintotheexistingmedical recordsystemofthescreeningfacility.BCCPscreeningsiteswillfollowtheirfacilitiespolicyregardinglengthoftimetoretainpaper files.Ifpaperfilesarescannedand/oravailableinelectronicformat,thereisnoneedtoretain papercopiesofBCCPdataforanygivenperiodoftime.AllBCCPpaperworkand/ordatashouldbeshreddedinaconfidentialmannerupontermination ofretentionpolicy.Detailedmedicalrecordsand/ornotesshouldNOTbeforwardedtothestateBCCPoffice.Only pertinentBCCPdataformsshouldbeforwardedtotheStateBCCPoffice.

RESCREENING BecausetheultimategoaloftheBreast&CervicalCancerProgramistoreducedeathand morbidityfromthesediseases,itisimperativeforclientstoreturnforrescreening,accordingto recommendedscreeningguidelines.Clientspreviouslyenrolledintheprogramandwhocontinuetomeeteligibilityrequirementswill begivenpriorityforrescreening.QualityAssurancemonitoringofrescreeningrateswillbeperformedmonthlybythestateBCCP office.RatesofCBE,mammographyandPaptestswillbeconductedandmonitoredat12month intervals. WhenaclientenrollsintheBCCP,enrollmentstaffwillinformtheclientthattheprogramis

availableonanannualbasis,providedeligibilitycriteriaismet.

Whentheenrolledclientmeetswithahealthcareprovider,theywillbecounseledontheneedforroutinescreening,including:clinicalbreastexams,mammograms,pelvicexams,andPapTests.

BCCPscreeningsiteswillreceivemonthlynotificationfromthestateBCCPoffice,ofclients

whohavemissedtheirappointment.Screeningsitesshouldfollow‐upwithclientstoschedulescreeningsrespectively.Ifanychangeshaveoccurredintheclient’sstatus(i.e.,moved,changeofhealthinsurancecoverage,etc…)–theBCCPsitecoordinator/casemanagerwillnotifythestateBCCPofficeinatimelymanner.

BCCPscreeningsitesareencouragedtoaugmentcentralizedmailingswithlocalreminder

letters,postcardsorphonecalls.

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NEW HAMPSHIRE RESIDENCY AllprogramenrolleesmustresideinNewHampshireoraborderingMainetown*.AreciprocalagreementisinplacebetweentheNewHampshireBCCPandtheMaineBreast andCervicalHealthProgram,whereby*MaineresidentsresidingneartheNewHampshire bordercanbeenrolledintheNewHampshireBCCP.Non‐residentsofstatesotherthanMainewillbereferredtotheBreastandCervicalCancer ScreeningProgramintheirstate.Seethefollowingsiteforalistingofnationalprograms: https://nccd.cdc.gov/dcpc_Programs/index.aspx#/1.Postofficeaddressescannotbeusedtodetermineresidency.Ifaclientutilizesapostofficebox formailingpurposes,pleasealsoincludeaphysicaladdressintheenrollmentsectionofBCCP.

TERMINATION OF BREAST AND CERVICAL CANCER PROGRAM SCREENING SITE

Whenacontractisterminatedwithascreeningsite,clientswhohavebeenenrolledintheBCCP throughtheterminatingsitearestillconsideredtobeenrolledintheBCCP. AllBCCPclientswillbenotifiedatleast30dayspriortothecontractterminationdate.Clients willbeprovidedwithalistofatleasttwonearbyBCCPscreeningsiteswherecopiesoftheirBCCP screeninganddiagnosticrecordscanbetransferredandwheretheycangoforfuture rescreening. ThestateBCCPofficewillbeadvisedofwhereeachclient’srecordisbeingtransferred.Original recordswillbestoredattheoriginalscreeningsiteinthesamemannerasallotherrecordsof formerclientsoftheterminatingBCCPscreeningsite. Clientswillbenotifiedthroughcertifiedmail,returnreceiptrequested,thatthesitewillno

longerbeaBCCPscreeningsite.

Clientswillbeprovidedacontactnameandphonenumbertocall,tonotifythescreeningsiteofwheretheychoosetohavecopiesoftheirrecordssent.

LANGUAGE INTERPRETATION

Allcontractorsshallhaveawrittenpolicyinplaceforaddressingthefollowing: assessinginterpreterneedsofBCCPclients,and determiningappropriatequalificationsformedicalinterpreters.

TheBCCPwillprovidereimbursement,ataratetobedeterminedannually,forall interpreter costsforBCCPclientsneedinglanguageinterpretation.Reimbursementwillnotbeavailableto offsetthecostofsalariedagencystaff.Reimbursementwillonlybeprovidedincaseswhere additionalexpenseisincurredforinterpretationservices.

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Ifaclientisfoundtobeinneedoflanguageinterpretation,aninterpretermustbeavailableforallsubsequentinteractions,includingbutnotlimitedto:formcompletion,allone‐on‐oneinteractionswiththeclient,andfollow‐uptelephonecallsandappointments.

Pertinentinformationshallbeprovidedtotheinterpreter,priortotheinteractionwiththe

client,includingbutnotlimitedto:thenameoftheclient,languageanddialect,approximatelengthoftimeserviceswillbeneededandothernecessarydetailsoftheinteraction.Documentationofthepresenceoftheinterpretershallbeprovidedintheclient’srecord.

Ifaclientrefusesinterpretationservices,whenthatclienthasbeenfoundtobeinneedoflanguageinterpretation,informationoftheclient’srefusalshallbedocumentedintheclient’srecord.

Ifaclientrefusesinterpretationservicesanddesiresafriendorfamilymemberasaninterpreter,atrainedinterpretershallbepresenttowitnessallinteractions,toinsuretheaccuracyoftheinterpretation.Aminorshouldnotbeusedforinterpretation.

Agencystaffmustbeavailabletoreviewallpaperworkwithaclient.Atnotimeshallaninterpreterbeexpectedtoreviewpaperwork.Aninterpreterwillbeavailabletointerpretlanguagefortheagencystaffandclient.

Aninterpretershallnotbeusedasawitnessontheinformedconsentform.

AnyagencystaffprovidinginterpretationservicesforBCCPclients,shallhavecompletedmedicalinterpretationtraining.

RESIGNATION/TRANSFER OF BCCP

SITE COORDINATOR/CASE MANAGER PRIORtoasitecoordinator/casemanagerleavingtheirpositionatascreeningsite,itis importanttonotifytheBCCPstateofficeassoonaspossibletoensureanefficienttransitionof responsibilities.Assoonasasitecoordinator/casemanageridentifytheyareleavingtheirpositionintheBCCP, thePublicHealthNursemustbenotified. ThestateBCCPPublicHealthNursemustbeprovidedwiththenameofacontactpersonifthere isabreakbetweennewsitecoordinator/casemanagers. Stateofficestaffwillcoordinateandconductorientationtrainingwithnewstaff.

TOBACCO SCREENING AND CESSATION AllprovidersmustassessthesmokingstatusofeveryclientscreenedbytheBCCPandreferthose whosmoketotobaccoquitlines.Itiswellknownthattobaccouseisassociatedwithmanycancersandchronicdiseasesthat impactthehealthofournation.Asachronicdiseasepreventionpriority,ourpublichealthcancerscreeningprogramscan promotethehealthofourclientsbyprovidingthisgreatservicewhiletakinglittleeffort.

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CDCwantstoencourageproviderstoassessallclientsasastandardofpractice,whetheror nottheyareBCCP‐eligibleclients.CDCiscurrentlynotrequiringthattherebedocumentationofthisintheclientrecordnorin theMDE(minimumdataelement)submission.

Tobaccocessationresourcesandquitlinereferralsaremadeasnecessary.http://quitnownh.org/.Telephone:1‐800‐784‐8669.

CASE MANAGER/SITE COORDINATOR

JOB DESCRIPTION SCOPEOFWORKTomanagetheBreastandCervicalCancerProgram,assuringthatallBCCPstandards,asoutlined inthePolicyandProceduresManual,aremet.DUTIESANDRESPONSIBILITIESDetermineclienteligibility.

Coordinateclientappointmentsandreferrals.

Establishasystemfortheannualrecallforscreeningofeligibleclients.

AssurethatcasemanagementrequirementsoftheBCCParemet.

Developawrittencasemanagementplanforclientswithabnormalscreeningand/orpositive diagnosticfindings,andmonitorthroughcompletion.

ReviewallclientdataforcompletenessandclinicallogicbeforesubmissiontotheBCCPstate office.

Maintainaresourcelistoflocal,stateandnationaldiagnosticandtreatmentlocations.

Prepareresponsetosemi‐annualReviewQualityAssuranceReports.

Availableforperiodicsiteevaluation.

Availableformeeting/trainings.MINIMUMQUALIFICATIONSAhealthcareprofessional,preferably,aregisterednursewithacurrentNewHampshirelicense, orarelatedhealthcarefield,workingunderthedirectsupervisionofaregisterednurseorAPRN.

PATIENT NAVIGATION, CASE MANAGEMENT AND COMMUNITY HEALTH WORKERS (CHWs)

INTRODUCTIONTheNewHampshireBreastandCervicalCancerProgramrecognizesthatprovidingcase managementservicesforclientswithabnormalclinicaltestresultsisanessentialcomponentof theBCCP.However,itmustalsoberecognizedthatmanyclientsentertheprogramwithbarriers thatpreventthemfrombeingabletoobtainormaintaingoodhealth.Patientnavigation,

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therefore,mustbeestablishedasanongoingprocessofidentifyingandresolvingbarriers startingatthetimeofenrollment.Eachclientmustbeassessedcontinuallyforbarriersthatwouldpreventthemfromobtaining screeningservices,understandingscreeningtestprocedures,understandingscreeningtest resultsandreceivingthenecessaryfollow‐upservices.TARGETPOPULATIONFORCASEMANAGEMENTAllclientsenrolledintheBCCPwillbeprovidedcasemanagementandpatientnavigationservices asneededatkeycrossroadsofcare,including:timeofenrollment,negativefindings,short‐term follow‐up,andabnormalresults.PATIENTNAVIGATIONDEFINEDForpurposesoftheNBCCEDP,patientnavigationisdefinedas,“Individualizedassistanceoffered toclientstohelpovercomehealthcaresystembarriersandfacilitatetimelyaccesstoquality screeninganddiagnosticsaswellasinitiationoftreatmentservicesforpersonsdiagnosedwith cancer.”COMMUNITYHEALTHWORKERS(CHWs)CommunityHealthWorkers(CHWs)aretrusted,knowledgeablefrontlinehealthpersonnelwho typicallycomefromthecommunitiestheyserve.CHWsbridgeculturalandlinguisticbarriers, expandaccesstocoverageandcare,andimprovehealthoutcomes.CHWsgenerallydonothave (orneed)amedicalbackground,althoughmanyservinginthisrolearemedicalassistants.Communityhealthworkers'(CHWs)rolesandactivitiesaretailoredtomeettheuniqueneedsof theircommunities,andalsodependonfactorssuchaswhethertheyworkinthehealthcareor socialservicessectors.Generally,theirrolesinclude:Creatingconnectionsbetweenvulnerable populationsandhealthcaresystems.TheNHBCCPhelpsfundseveralCHWswithinBCCPscreeningsites.Thesestaffprovideoutreach andsupporttoclients,withthegoalofincreasingbreastandcervicalcancerscreeningrates throughvariousevidencebasedinterventionssuchas:clientreminders(letter,postcard, telephonemessage),one‐on‐oneeducationandmotivationalinterviewing,andaddressingclient barriers(i.e.financial,transportation).CHWsworktoincreasebreastandcervicalcancerscreeningratesfortheirentirefacility, regardlessofwhatformofinsuranceorfinancialassistanceaclienthastoreimbursefor screenings.CHWsdoNOTworkspecificallywithBCCPclients.CHWsreporttoahealth professional(i.e.RNorAPRN)andhaveavailabletheirclinicalexpertisewhenneeded,especially incasesofabnormalscreeningtestresults.PATIENTNAVIGATIONOBJECTIVESFORNHBCCPToprovidenotificationofscreeningresultswithin30daysofthescreeningdate.Toprovidenotificationofabnormalscreeningresultswithin48hoursofreceiptbythecase manager.Tocompletediagnosticworkupwithin60daysofinitialscreeningdate.Toinitiatetreatmentwithin60daysofthedateofdiagnosisofcancer.

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Toprovidediagnosticwork‐upfor100%ofabnormalscreens.Toinitiatetreatmentfor100%ofdiagnosesofCINII,CINIII/CIS,andcervicalcancer.Toinitiatetreatmentfor100%diagnosesofDCIS,LCIS,andinvasivebreastcancer.Tomaintainthetotal“refused”and“losttofollow‐up”categoriesforclientsatfewerthan5%of allclients.

CASE MANAGEMENT & ENROLLMENT ENROLLMENTMINIMUMSTANDARDSAssessmentAssesswhethertheclientmeetsBCCPeligibilitycriteria.

Assesswhetherbarrierstoattendingappointmentsdeterparticipation.

Assesswhetherspecialassistanceisrequiredtocompleteformsand/orgiveinformedconsent.

Assesswhetherenrollmentandconsentformsareaccuratelyandentirelycompleted,including signatureofclientandwitness.PlanningPlanwiththeclientthebesttimesforappointmentsandassisttoscheduleanyadditionalneeded screeningappointments,suchasmammography.CoordinationCoordinateanyspecialassistancerequiredforclientstogainaccesstoscreeningfacilities.

Coordinatewithmammography/radiologyforneededscreeningappointments.MonitoringMonitorthatresultsarecommunicatedtoclientinatimelymanner(goalof<30days).EvaluationEvaluatethetimelinessofscreeningresultsgiventoclient(goalof<30days).

Evaluateclientsatisfactionwithscreeningservices.

Evaluateclinicprocessforseamlessdeliveryofservicesandanybuiltindelays.

EvaluatecompletenessandtimelinessofformssubmittedtoBCCP.

CASE MANAGEMENT & NEGATIVE FINDINGS

PURPOSETonotifyeachclientofscreeningresultsandeducatethemabouttheimportanceofroutine screeninginordertodetectcancerattheearliesttimewithhighestchancesforcure.AssessmentAssessclientunderstandingofscreeningtestresults.

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AssessclientunderstandingthattheBCCPisanongoingprogramavailabletothemfor rescreeningaslongastheymeetestablishedeligibilitycriteria.PlanningPlanwithclientwhennextroutinescreeningshouldtakeplace.

Planwithclientsothatrecall/reminderlettersshouldbeexpectedatcertainintervalsinthe future.CoordinationCoordinatewithclient’sPrimaryCareProvider.Alldocumentedcancerscreeningresultsshould besharedwhenappropriateandauthorizedbytheclient.MonitoringMonitorthatresultsofscreeningtestswerereturnedtotheclientpromptly.EvaluationEvaluatetimelinessofreturnofscreeningtestresults.

Evaluateclientsatisfactionwithservicesprovided.

EvaluatecompletenessofformsandtimelinessofsubmissiontoNHBCCP.

CASE MANAGEMENT & SHORT TERM FOLLOW-UP PURPOSEToassurethatclientswithresultsrequiringre‐evaluationpriortoannualscreeningshaveacase managementplanthatfollowsrecommendedclinicalguidelinesforshort‐termfollow‐up.AssessmentAssesstheclient’scapacitytounderstandscreeningtestresultsandrecommendedstepsin diagnosticfollow‐up.

Assessclient’sneedforadditionaleducationalmaterialsregardingdiagnostictestingprocedures.

Assessbarrierstonextrecommendeddiagnostictesting/procedure.

Assesssupportsystemoftheclient.

Assessadditionalindividualcomplicatingfactorssuchaspre‐existingillness,physical,emotional orpsychologicallimitations.

PlanningPlanwiththeclientthebestappointmentdatesandtimesandhowtheywillgetthere.

Planwiththeclientemotionalsupportstheywilluseuntilalldiagnosticfollow‐upiscomplete.CoordinationCoordinatewithdiagnostictestingfacilitiesregardingfacilityaccessneedssuchastransportation, childcareorotherpertinentconcernsoftheclient.

Coordinatethemannerinwhichresultswillbereturnedtotheclientandcasemanagerorsite coordinator.

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MonitoringMonitorthatresultsoftestingarereturnedtotheclientandcasemanagerorsitecoordinatorina timelyfashion.

Monitorthecompletionofrecommendeddiagnostictesting.EvaluationEvaluatetimelinessofreturnofresultstotheclient.

Evaluateclientsatisfactionwithservicesreceived.

Evaluatewhethernotificationofabnormalscreeningresultstookplacewithin48hoursofreceipt bythecasemanager.

Evaluatewhetherthetotal“refused”and“losttofollow‐up”categoriesforclientsisfewerthan 5%ofallclients.

CASE MANAGEMENT & ABNORMAL RESULTS PURPOSEToassurethatclientswithabnormalscreeningtestresultshaveacasemanagementcareplan thatwillnavigatethemtoadequateandtimelydiagnosticandtreatmentservicesthatfollow recommendedclinicalguidelinesforthemanagementofabnormalresults. Abnormaltestresultsrequiringcasemanagementinclude:Mammography assessmentincomplete suspiciousabnormality highlysuggestiveofmalignancyPapTests resultsthecliniciandeterminesrequirefollow‐up highgradeSIL squamouscellcarcinoma

CBE resultsthecliniciandeterminesrequirefollow‐up distinctpalpablebreastmass skindimplingorretraction nippledischargethatisbloodyorunilateral,spontaneous,localizedtooneduct skinretractionorscalinessaroundnipple clientreportofpainorothersymptomsClientsidentifiedashighriskduetopresentingsymptoms(breastlump,painornippledischarge) orotheridentifiedriskfactors(multiplesexpartners,positivefamilyhistory,etc.)mayalso requiremoreextensivecasemanagementbeginningatthetimeofenrollment.

Closemonitoringandtrackingisrequiredforclientswithdiagnosticresultsindicatingsuspicious forcancer.Thecasemanagerorsitecoordinatormusthaveawrittenplanofcaredocumentedin thechartandareminder/recallsysteminplacethatassuresnotificationofabnormalresultsand missedfollow‐updiagnostictestingappointments.

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Clienteducation,treatmentoptionreview,identificationofavailableresources,evaluationof barrierstoschedulingandreceiptoftreatmentarecrucialelementsofthecasemanagement process.CompletionofadditionaldiagnosticreportdataisrequiredtobeforwardedtotheNH BCCPinatimelymanner. Itisimportanttoassuretimelynotificationtotheclientregardingtheirresults.Utilization

ofaninternaltrackingsystemwillassuretheretrievaloftimelyresults.Notificationofabnormalresultsshouldbelessthan48hoursfromreceiptoftheresultsbythecasemanager.

Clientsmustbenotifiedofabnormalresultsandfurtherdiagnostictestingand/ortreatment

scheduledandcompletedinatimelymanner.Diagnosticworkupshouldbecompletedinlessthan60daysfrominitialscreeningdate,initiationoftreatmentshouldbelessthan60daysfromdateofdiagnosisofcancer,andclientswhorefusetreatmentorarelosttofollow‐upshouldbelessthan5%ofallclients.

Communicationofresultsshouldbeprompt,accurateandprovidedinwriting.Failuretodo

somaycauseundueanxietyfortheclientorcouldleadtodelayeddiagnosisandreducedtreatmentoptions.Inallsituations,writtencommunicationmaybeprecededbyoralcommunicationonsiteorbytelephone.Allcommunicationwiththeclientshouldbedocumented.

Allfollow‐upcontactsand/orattemptstocontactclientsandmedicalprovidersshouldbedocumentedintheclient’schart.

Allclientswithabnormalresultsmustbenotifiedofresultsregardlessofclient

status/eligibility(address,income,insurancechange). Educationalmaterialsdescribingdiagnostictestingprocedures,expectedoutcomes,and

consequencesofdelayornon‐treatment,shouldbesuppliedtotheclientasneededonanindividualbasis.

Acopyoftestresultsshouldbeforwardedtotheclient’sprimarycareprovide.

Iftheclientisnotreachablebyphoneafteraminimumofthree(3)attemptsatvarious

timesofthedayandevening,acertifiedletteraskingtheclienttocontacttheofficeimmediatelyshouldbesent.Thelastattemptatcontactpriortodischargefromservicemustbebycertifiedletter.Acopyofthedischargeshouldbeplacedintheclient’srecordandforwardedtotheclient’sprimarycareprovider.

Whenanalternatecontactnameandphonenumberhasbeenenteredintotherecord,this

personmayalsobecontactedtoaideinclientlocation.Writtencontactmaymentionintenttodischargefromcareifthatisagencypolicy.Agencypolicyshouldbefollowedregardingdischargefromcareandcontinuanceofeffortstocontacttheclient.

Whenaclientisreachedbutrefusesrecommendeddiagnostictestingortreatment,itis

importantthatthecasemanagerdetermine,asmuchaspossible,thereasonsforrefusal.Anoptionalhomevisitmaybemadeatthistime.Iftheclientisnothome,educationalmaterialsandagencycontactmaterialsshouldbeleftatthehome,andacopyofthesematerialsplacedintheclient’srecord.

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ClientsinneedoffinancialsupportshouldreceivecounselingregardingresourcesavailablethroughtheBCCPscreeningsiteaswellaslocal,stateandnationalresources.Financialconcernsshouldnotbeafactorfordeclineofservices.Total“refused”and“losttofollow‐up”categoriesforclientsshouldbefewerthan5%ofallclients.

Whenaclientrefusesandwillnotreconsidertheirdecisiontodeclinediagnosticor

treatmentservices,acertifiedlettershouldbemailed,outliningtheconsequencesoftherefusaltotheclient.Acopyshouldbeforwardedtotheclient’sprimarycareprovider.Itisrecommendedthatfortheclientwhorefusesdiagnostictestingand/ortreatmentreceiveatleastoneadditionalcontactattheendofsixmonths.

Ifaclientrefusesrecommendedfollow‐upservicesbutchoosestocontinuewithannual

screening,theprogramshouldrecalltheclientforannualscreening,regardlessofwhethertheypreviouslyrefusedorwaslosttofollow‐up.

Reviewwiththeclienttheimportanceofcontinuedannualscreeningandrecommended

follow‐upguidelinesaftercompletionoftherecommendeddiagnostictestingand/ortreatment.Atthistime,theclientshouldbeplacedintotheannualre‐screeningandrecallpoolasappropriate.

AssessmentAssesstheclient’scapacitytounderstandtestresultsandtreatmentoptionspresented.

Assessclient’sneedforadditionaleducationalmaterials.

Assessbarrierstonextrecommendeddiagnostictesting/procedureand/ortreatment.

Assesssupportsystemoftheclient.

Assessadditionalindividualcomplicatingfactorssuchaspre‐existingillness,physical,emotional orpsychologicallimitations.PlanningPlanandexplaintotheclientthenextstepinthediagnosticprocedure.

Planbestappointmentdatesandtimesandhowtheclientwillgetthere.

Planwiththeclient,emotionalsupportstheywilluseuntilalldiagnosticandtreatmentmodalities arecompleted.

CoordinationCoordinatewithtestingfacilities:access,transportation,childcareorotherpertinentconcernsof theclient.

Coordinatethemannerinwhichresultswillbereturnedtothecasemanagerorsitecoordinator. MonitoringMonitorthatresultsoftestingarereturnedtotheclientandcasemanagerorsitecoordinatorina timelyfashion.

Monitorthecompletionofrecommendeddiagnostictestingand/ortreatmentsequence.EvaluationEvaluatetimelinessofreturnofresultstotheclient.

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Evaluateclientsatisfactionwithservicesreceived.

Evaluatewhethernotificationofabnormalscreeningresultstookplacewithin48hoursofreceipt bythecasemanagerorsitecoordinator.

Evaluatewhetherthetotal“refused”and“losttofollow‐up”categoriesforclientsisfewerthan 5%ofallclients.

CLINIC EDUCATION Eachclientshouldreceiveaneducationalinterventionattheirscreeningappointment.Topicsdiscussedshouldinclude: Thescreeningguidelinesforbreastandcervicalcancer,emphasizingtheimportanceof

regularscreening.

Factorsthatwillputaclientathighriskforbreastandcervicalcancer.

Theimportanceofearlydetection.

Howtheclientwillreceivetheresultsoftheirscreeningtests.

Thelimitationsofthescreeningprocedures.

CPT CODES AND RATES ALLOWABLECPTCODES BCCPreimbursementratesarebasedonthehighestallowableMedicareratesforNew

Hampshire. ProvidersandBCCPvendorsmustaccepttheCPTrateasfullpaymentforservices.balances

mayNOTbebilledtotheclient. AlternativearrangementsshouldbemadeforpayingbillsnotincludedontheBCCPCPTcode

list.

CPTCodeListsareupdatedyearlyandpostedonthefollowingwebsites:www.getscreenednh.com

http://www.dhhs.nh.gov/dphs/cdpc/bccp/index.htm

PUBLIC EDUCATION and OUTREACH PUBLICEDUCATIONPubliceducationisdefinedas:“increasingthenumberofclientsamongprioritypopulationswho usebreastandcervicalservicesby:raisingawareness,educating,addressingbarriers,and prompting,motivatingandsupportingclientstocompletetheseexamsasaroutinepartoftheir healthcare.”Howthestateprogramandindividualscreeningsitesareabletoreachclientswillimpactthe successoftheprogram.Throughtheidentificationofbarrierstoscreening,andprovidingmeans toovercomethebarriers,theBCCPisabletoenrollclientsmostinneedofongoingscreening services.

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Eachscreeningsitewillneedonetelephonenumbertopromotelocally,forclientstocallto scheduleappointments.ThisnumbershouldalsobeavailabletothestateBCCPofficesothat clientscallingcanbegiventhelocalnumber.TheBCCPcarriesoutastatewidepubliceducationcampaignthroughvariousmarketingand outreachinitiatives.Ingeneral,thetollfreenumber,1‐800‐852‐3345,ext.4931,ispromoted forclientstocallforinformationofwheretogoforscreening.Whenclientscallthe800number, theywillbegivenlocalnumberstocallforscreeningappointments.PromotionalmaterialsareavailablethroughthestateBCCPoffice.PleasecontacttheStateBCCP officeasneeded.Periodicallysiteswillbeprovidedwithupdatedpromotionalitemsand materials,especiallysurrounding“AwarenessMonths”suchasOctoberfor“BreastCancer AwarenessMonth”andJanuaryfor“CervicalHealthAwarenessMonth.” PROGRAMOUTREACHThestateBCCPofficecoordinatesstatewidemediapublicityandoutreach.BCCPcommunication initiativeshaveincluded: Pressreleasesandadvertisinginnewspaper,radio,andtelevision Partnershipswithbusinessandsocialserviceorganizationsthroughoutthestate Articlesandinterviewsonlocalradioandtelevision

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OUTREACH IDEAS FOR YOUR SCREENING SITE

ThestateBCCPofficehandlesmuchoftheprogram’smarketingandcommunicationinitiatives. However,weencourageindividualscreeningsitestodopubliceducationandoutreachinitiatives intheirlocalcommunities.Belowisacalendarofideastoreacheligibleclientsinyour community.

Also,pleaserefertotheCommunityGuideforPreventiveServicesforevidencebasedinterventionsthatincreasebreastandcervicalcancerscreeningrates:https://www.thecommunityguide.org/sites/default/files/assets/What‐Works‐Cancer‐Screening‐factsheet‐and‐insert.pdf

OUTREACHCALENDARJULY

Postercampaign:DistributeBCCPpostersinyourscreeningsitecommunity.Targetlocation:Churches,hairsalons,laundromats,postoffice.HelpfulHint:Askfellowstaffmemberstoassistyou.Provideeachpersonwith2to5posters andaskthemtopostinthecommunity.

Otheroutreachideas:AsthenewscreeningyearbeginseachJuly,sendalettertotheeditorof yourlocalnewspapertoremindthem,orinformthem,aboutBCCP.

OCTOBER

Postercampaign:DistributeBCCPpostersatyourcommunityareas.Targetlocation:Libraries,districtoffices,townhalls.HelpfulHint:Bringaposterandbrochurestoyourlocallibraryaskingthemtoset‐upadisplay topromoteNationalBreastCancerAwarenessMonth.ThelibrarycoulddisplayBCCP materialswithbooksfocusingonbreasthealthandbreastcancer.

Otheroutreachideas:Holdabreastcancerawarenesseventatyourscreeningsite.

FEBRUARY

Postercampaign:DistributeBCCPpostersatlocalgrocerystores.Targetlocations:Supermarkets,conveniencestores,and“mom&pop”stores.HelpfulHint:Askfellowstaffmemberstobringapostertothegrocerystorewhentheygo shopping.

Otheroutreachideas:Opportunitytoshare:contactlocalradiostationstoseeiftheywouldlike tointerviewyouaboutBCCP.

MAY

Postercampaign:DistributeBCCPpostersatlocalbanksandpharmacies.Targetlocation:Banksandpharmacies.HelpfulHint:Callaheadtoseeifthebusinessiswillingtopostyourmaterials.Otheroutreachideas:Ifyouhaveacommunitynewsletter,requestthatanarticleor announcementbeincludedabouttheprogram.

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ORDER FORM - EDUCATIONAL MATERIALS and INCENTIVE MATERIALS

Item Qty25 Qty50 Qty100Brochure‐English Brochure‐Spanish Brochure‐French Brochure‐Bosnian Brochure‐Portuguese Brochure‐Arabic Brochure‐Napali Brochure‐Mandarin Brochure‐Vietnamese Two‐SidedPurpleHeartCard‐English Two‐SidedPurpleHeartCard‐Spanish Two‐SidedPurpleHeartCard‐Portuguese PinkInformationPostCard‐English PinkInformationPostCard‐Spanish EnrollmentCard‐English

IncentiveItems‐*availableitemsandquantitiesdovary Qty25 Qty50 Qty100PinkPens Posters LipBalm EmeryBoards Other:_______________________________________________

DataForms Form# PackageQtyEnrollmentForm(indicateEnglishorSpanish) 1A InformedConsent(indicateEnglishorSpanish) 1B ScreeningDataForm 2 BreastDiagnosticandTreatmentDataReportingForm 3 CervicalDiagnosticandTreatmentDataReportingForm 4

MAIL MATERIALS TO: CONTACT NAME: ORGANIZATION: ADDRESS:

MAILORFAXYOURORDERTO:Breast&CervicalCancerProgramAttn:ProgramSecretary29HazenDr.Concord,NH03301‐6504Phone:271‐4931/Fax:271‐05391‐800‐852‐3345ext.4931

Pleaseallowoneweektoprocessyourorder

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STATE BCCP OFFICE MAILING ADDRESS AND CONTACT INFORMATION

OURMAILINGADDRESS:

NewHampshireDepartmentofHealthandHumanServices

DivisionofPublicHealthServicesBreastandCervicalCancerProgram

29HazenDriveConcord,NH03301

FAXNUMBER603‐271‐0539

PHONENUMBER603‐271‐4931

OR1‐800‐852‐3345ext.4931

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STATE BCCP OFFICE STAFF INFORMATION

WhitneyHammond,Administrator,(whitney.hammond@dhhs.nh.gov).......... 271‐4959TiffanyFuller,ProgramCoordinator,(tiffany.fuller@dhhs.nh.gov)………………… 271‐4886StaceySmith,PublicHealthNurse,(stacey.smith@dhhs.nh.gov).….…….…………. 271‐4621KristenGaudreau,DataManager,(kristen.gaudreau@dhhs.nh.gov)........….….. 271‐5932

MariSchaffer,AdministrativeSecretary,(maricela.schaffer@dhhs.nh.gov).……. 271‐4931

Forquestionsregarding: Call BCCPPolicy&Procedures WhitneyHammond 271‐4959Contracts,PublicEducation TiffanyFuller 271‐4886Outreach,Communications CaseManagement,Professional StaceySmith 271‐4621Development,QualityAssurance,ClinicalGuidance,MedicaidDataCollection,Billing KristenGaudreau 271‐5932GeneralInformation,OrderingForms, MariSchaffer 271‐4931OrderingSuppliesTollfree:1‐800‐852‐3345EXT.4931/FAX271‐0539

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RESOURCES

AmericanCancerSociety http://www.cancer.org/docroot/home/index.aspAmericanSocietyforColposcopyandCervicalPathology(ASCCP) http://www.asccp.org/BreastandCervicalCancerMortalityPreventionAct http://www.cdc.gov/cancer/nbccedp/legislation/law.htmBreastandCervicalCancerPreventionandTreatmentActof2000‐TitleXIX(amended) http://www.cdc.gov/cancer/nbccedp/legislation/law106‐354.htmCancerControlPlanet http://cancercontrolplanet.cancer.gov/FederalPovertyGuidelines http://aspe.hhs.gov/poverty/NationalBreast&CervicalCancerEarlyDetectionProgram(NBCCEDP) http://origin.cdc.gov/cancer/nbccedp/NationalCancerInstitute(NCI) http://www.cancer.gov/NewHampshireDepartmentofHealthandHumanServices http://www.dhhs.nh.gov/NewHampshireStateCancerRegistry http://www.dartmouth.edu/~nhscr/SusanG.KomenfortheCure http://ww5.komen.org/UnitedStatesPreventiveServicesTaskForce(USPSTF) http://www.ahrq.gov/clinic/uspstfix.htm

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