Breast and Cervical Cancer Services Policy Manual

Appendix I, Medicaid for Breast and Cervical Cancer (MBCC) Application Checklist

Revision 24-3; Effective Dec. 9, 2024

Note: Incomplete MBCC applications must not be submitted to BCCS.

MBCC Application (H-1034)

Answer all questions and fill in every blank on the H-1034 as follows:

  • Verify the client’s legal name, date of birth and Social Security number are correct.
  • Verify presumptive eligibility has been met.
  • Verify the client has a biopsy-confirmed and qualifying diagnosis. See Appendix II, Medicaid for Breast and Cervical Cancer (MBCC) Guidelines.
  • Verify the date of the diagnosis matches the collection date on the biopsy pathology report.
  • Check for unpaid medical bills for services that were received three months before date of application submission — Indicate yes or no and months when they occurred if applicable.
  • Do not mark in the HHSC Agency Use Only section.

Attach copies of the following supporting documents:

  • The final pathology report with the biopsy-confirmed, qualifying diagnosis, with no highlighting
  • Verification of identity, U.S. citizenship or legal immigrant status

Email HHSC Centralized Benefit Services (CBS) for additional information about citizenship and immigrant status.

If the client’s insurance is expired, terminated or does not cover cancer treatment, check for both of the following:

  • Copy of insurance card
  • Letter or explanation of benefits from insurance company

If the client’s  qualifying diagnosis was more than one year ago, check for the following:

  • Physician letter that specifies active treatment needed or
  • Recent medical documentation that supports a need for active treatment

Note: Do not fax tax forms, pay stubs or any other financial documents. Clients may not self-declare income. Financial documents must be kept with the client chart.

Med-IT

Enter client details and patient navigation in Med-IT® as follows:

  • Make sure enrollment status is correct:
    • Active — client received BCCS services before the cancer diagnosis.
    • MBCC Referred-In — client never received BCCS services, was diagnosed by a non-BCCS provider and was referred in for MBCC application only.
  • Make sure the navigation module is complete.
  • Bill with the appropriate patient navigation code.

Processing the H-1034

Fax or securely email the H-1034 to BCCS at 512-776-7203 or MBCCApps@hhs.texas.gov.

When the application is received, BCCS program staff:

  • requests additional information if needed; and
  • nurse consultants review and send the H-1034 to HHSC CBS.

Note: BCCS does not assist with or collect documents for MBCC applications following submission to CBS.

The status of a client’s application will be documented in the client’s Med-IT® record under enrollment notes when an application has been received and when it was sent to CBS for final eligibility determination. If there are no notes in the client’s enrollment record after three business days, you may send an email to mbccapps@hhs.texas.gov. Use the client Med-IT® identification number in the subject line. Exclude protected health information.

MBCC Application Status and Medicaid Number

Clients may call 211 for their application status and Medicaid number.

Appendix II, Medicaid for Breast and Cervical Cancer (MBCC) Guidelines

Revision 24-2; Effective Sept. 20, 2024

Guidelines for Determination of Qualifying Diagnosis

Texas Breast and Cervical Cancer Services (BCCS) provides the following guidance to health care providers and grantees to facilitate their determination of qualifying diagnoses for Medicaid for Breast and Cervical Cancer (MBCC). Analysis of all biopsies must be performed by a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory.

Cervical Cancer Qualifying Diagnoses

Qualifying precancerous cervical diagnoses must be biopsy-confirmed*:

  • High-grade dysplasia or cervical intraepithelial neoplasia (CIN 2/3 or CIN 3)
  • Carcinoma or adenocarcinoma in situ

Qualifying malignancies of the cervix must be biopsy-confirmed*:

  • Adenocarcinoma
  • Adenoid cystic carcinoma
  • Adenosquamous carcinoma
  • Glassy cell carcinoma
  • Invasive cervical cancer
  • Invasive endocervical adenocarcinoma
  • Invasive neoplasm
  • Malignant neoplasia
  • Melanoma
  • Sarcoma
  • Small cell carcinoma
  • Squamous cell carcinoma

* Cervical biopsy or endocervical sampling that have a qualifying pre- cancerous diagnosis or cervical malignancy qualify as biopsy confirmed.

Breast Cancer Qualifying Diagnoses

Qualifying breast cancer diagnoses must be biopsy-confirmed. On the pathology report, the diagnosis or the description of the specimen, or both, may include at least one of the following phrases: breast cancer, breast carcinoma or breast malignancy.

Examples of the majority of breast cancer types are:

Ductal Carcinomas

  • Comedo
  • Cribriform
  • Ductal carcinoma in situ (DCIS)
  • Infiltrating
  • Inflammatory
  • Invasive
  • Medullary
  • Mucinous (colloid)
  • Papillary or Micropapillary
  • Scirrhous
  • Tubular

Lobular Carcinoma*

  • Invasive
  • Infiltrating

Nipple Carcinoma

  • Paget’s disease

Other Carcinomas

  • Adenoid cystic carcinoma
  • All Phyllodes tumors
  • Any biopsy-proven malignancy identified in a biopsy of either breast
  • Apocrine
  • Carcinoma, NOS (not otherwise specified)
  • Carcinoma with endocrine differentiation
  • Metaplastic
  • Primary lymphoma
  • Sarcoma
  • Secretory
  • Undifferentiated carcinoma

* A diagnosis of lobular carcinoma in situ (LCIS) is not considered a qualifying pre-cancerous or breast cancer diagnosis for referral to MBCC.
 
For a medical condition to qualify as a breast cancer, the medical record documentation, such as the operative report or procedure note, must state that a biopsy was taken from at least one breast and a pathology report for that biopsy must confirm the diagnosis of a qualifying malignant lesion. The pathology report does not need to describe the malignancy as definitively representing a breast primary. A malignancy identified on at least one biopsy of the breast must be clear from the medical record documentation.

Metastatic Breast and Cervical Cancers

For  clients who present with cancers believed to be metastatic from the breast or cervix, if a diagnosis is made based only on the metastatic tumor, a Medicaid application may be considered if:

  • no further diagnostic workup is planned before treatment is initiated; and
  • treatment will proceed on the assumption that the primary source is breast or cervix, regardless that a primary tumor has not been identified.

The medical record documentation must clearly state that the primary source is believed to be breast or cervix and that treatment will be initiated based on that assumption. Terms such as compatible with and consistent with a breast or cervical cancer are acceptable. For example, a diagnosis such as metastatic adenocarcinoma consistent with a breast primary would be acceptable.

For  clients who present with cancers metastatic to the breast or cervix, malignancy diagnosed in a biopsy taken from a breast or from the cervix constitutes a qualifying diagnosis.

Appendix III, Program Resource Guide

Revision 23-2; Effective Sept. 29, 2023

Patient Education, Advocacy and Support

Program NamePhone NumberWebsiteServices
American Cancer Society800-277-2345www.cancer.org/
  • Guide to Quitting Smoking
  • Prescription Questions
  • Cancer education classes
  • Access to health care
  • Clinical trials
  • Stories of hope
  • Financial issues
  • Finding support groups
Know Your LemonsNot applicablewww.knowyourlemons.org
  • Patient education materials
  • Volunteer education training
Beyond the Brochure: Alternative Approaches to Effective Health CommunicationNot applicablewww.cdc.gov/cancer/nbccedp/pdf/amcbeyon.pdf
  • CDC manual that provides guidance to more effective health communication
  • Techniques
  • Strategies
  • Healthcare messaging
Health Equity Guiding Principles for Inclusive CommunicationNot applicablewww.cdc.gov/health-communication/php/toolkit/
  • Inclusive Communication Principles
Susan G. Komen Breast Cancer Foundation

877-465-6636
Education Helpline

Or email Helpline@komen.org

www.komen.org/
  • Breast health and breast cancer information
  • Emotional support services
  • Finding breast cancer services via an affiliate
National Cancer Institute Cancer Information Service800-422-6237
TTY: 800-332-8615
www.cancer.gov/
  • What is cancer?
  • Understanding treatment
  • Prevention of cancer
  • Free booklets on cancer
  • Information and website in Spanish
Cancer Prevention and Control- English800-CDC-INFO (232-4636)www.cdc.gov/cancer/
  • Cancer information
  • Survivorship information
Cancer Prevention and Control-Spanish800-CDC-INFO (232-4636)
TTY: 888-232-6348
www.cdc.gov/Spanish/cancer/
  • Cancer information
  • Information in Spanish
Livestrong Foundation

Call:

855-220-7777 for cancer support

877-236-8820 for general inquiries

www.livestrong.org/
  • Patient navigation
  • Survivorship
  • Clinical trial information
  • One-on-one support
  • Information for family members

Clinic Information

Program NamePhone NumberWebsiteServices
Susan G. Komen Breast Cancer Foundation877-465-6636www.komen.org/
  • Grants for providers
National Cancer Institute Cancer Information Service800-422-6237
TTY: 800-332-8615
www.cancer.gov/contact
  • Clinical trials
  • Research and funding
  • Cancer statistics
  • Cancer information
  • Drug dictionary
  • News releases
  • Grants
  • Provider training
The Community Guide404-498-1827www.thecommunityguide.org/
  • Strategies for providers to improve care
  • What Works Fact Sheets
  • Reminder systems
  • Incentives for patients
  • Funding and grants
  • Research
  • Education program development
  • Publications for patients
Cochrane Collaboration+44-207-183-7503
(London, UK)
www.cochrane.org/

Objective evidence-based strategies to improve healthcare delivery

  • Case management
  • Provider reminder systems
  • Provider feedback
Texas Department of State Health Services Community Health Worker or Promotor(a) Training and Certification Program

CHW Certification 
512-776-2570 or 512-776-2624

Instructor or Training Program Certification
512-776-2777 or 512-776-2208

Email: chw@dshs.texas.gov

Fax: 512-776-7555

www.dshs.texas.gov/mch/chw/Community-Health-Workers_Program.aspx
  • CHW training and certification
  • CHW resources, including training manuals
  • Advisory Committee
  • Training locations

Evidenced-Based Interventions and Strategies

Program NameWebsiteServices
The Community Guidewww.thecommunityguide.org/
  • Strategies for providers to improve care
  • What Works Fact Sheets
  • Reminder systems
  • Incentives for patients
  • Funding and grants
  • Research
  • Education program development
National Cancer Instituteebccp.cancercontrol.cancer.gov/index.doEvidence-Based Cancer Control Programs (EBCCP)
National Association of Community Health Workers (NACHW)nachw.org/
  • Community Health worker resources
  • Guidance for policy development
  • Learning collaboratives

Appendix IV, Resources and Contacts

Revision 24-2; Effective Sept. 20, 2024

BCCS Program Information

ContactInformation
Fax512-776-7203
Help Line512-776-7796
Med-IT® AssistanceMed-ITHelpdesk@hhs.texas.gov
Program AssistanceBCCSProgram@hhs.texas.gov
Contract SupportFCS_Finance@hhs.texas.gov
FCS_Contracts@hhs.texas.gov
BCCS Websitewww.healthytexaswomen.org/healthcare-programs/breast-cervical-cancer-services
Clinic Locator — BCCS and MBCC Serviceswww.healthytexaswomen.org/healthcare-programs/breast-cervical-cancer-services

Medicaid for Breast and Cervical Cancer (MBCC) Information

ContactInformation
Fax512-776-7203
Application Statuswww.med-itweb.com
MBCC AssistanceMBCCApps@hhs.texas.gov
Renewal Paperwork2-1-1
Medicaid Provider Line800-925-9126
Medicaid Covered Services800-335-8957
TMHPwww.TMHP.com
Health and Human Services Commission — Centralized Benefit ServicesCBS_MBCC@hhs.texas.gov
Transportation Assistance877-MED-TRIP (877-633-8747)
Texas Medicaid Wellness Program800-777-1178

Additional Cancer Resources

ContactInformation
Livestrong Foundationwww.livestrong.org
855-220-7777
American Cancer Societywww.cancer.org
800-227-2345
Patient Advocate Foundation (Access, Job Retention, Financial Assistance and Debt)www.patientadvocate.org
800-532-5274
Clinical Trialshttps://clinicaltrials.gov/
CancerCarewww.cancercare.org

Appendix V, Monthly Income Standard Based on 2024 Federal Poverty Level (FPL)

Appendix VI, BCCS Billing Guideline

Revision 24-3; Effective Dec. 9, 2024

Appendix VII, Med-IT® Learned of Program and Cycle Referral Reminder