RULES AND REGULATIONS
Title 55--PUBLIC WELFARE
DEPARTMENT OF PUBLIC WELFARE
[55 PA. CODE CH. 140]
Special MA Eligibility Provisions
[37 Pa.B. 2180]
[Saturday, May 12, 2007]The Department of Public Welfare (Department), under sections 201(2) and 403(b) of the Public Welfare Code (62 P. S. §§ 201(2) and 403(b)) and section 1902(a)(10)(A) (ii)(XVIII) of the Social Security Act (42 U.S.C.A. § 1396a(a)(10)(A)(ii)(XVIII)) (Title XIX), regarding state plans for medical assistance, adds Chapter 140, Subchapter E (relating to the categorically needy breast and cervical cancer prevention and treatment program for qualified women). Notice of proposed rulemaking was published at 34 Pa.B. 6335 (November 27, 2004).
Purpose of Final-Form Rulemaking
The purpose of this final-form rulemaking is to take advantage of a Federal option in the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Pub. L. No. 106-354, 104 Stat. 409) (BCCPT Act), which amended section 1902(a)(10)(A)(ii)(XVIII) of the Social Security Act. The BCCPT Act permits states to provide Medical Assistance to women under 65 years of age who have been screened for breast or cervical cancer through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Individuals must be diagnosed and found to need treatment for either breast or cervical cancer or a precancerous condition of the breast or cervix. Coverage is limited to women who are ''uninsured,'' which is defined in § 140.702 (relating to definitions) as lacking ''creditable coverage'' as that term is defined in the Health Insurance Portability and Accountability Act (HIPAA) (section 2701(c) of the Public Health Service Act (42 U.S.C.A. § 300gg(c)(1)), regarding increased portability through limitation on preexisting condition exclusions.
Consistent with the BCCPT Act, providers and facilities funded in full or in part by the CDC are authorized to screen women only. Breast cancer is the most common form of cancer diagnosed among women in this Commonwealth and the second most common cause of cancer deaths for women in this Commonwealth (www.health. state.pa.us/stats). Cervical cancer, while less common than breast cancer, is one of the most successfully treatable cancers, if detected at an early stage (www. health.state.pa.us/stats).
The BCCPT Act amended Title XIX of the Social Security Act. The Commonwealth has elected this option and published a notice of intent at 32 Pa.B. 115 (January 5, 2002) to implement the Breast and Cervical Cancer Prevention and Treatment Program (BCCPT Program). The Commonwealth's State Plan Amendment to provide Medical Assistance under the BCCPT Program to uninsured women screened and diagnosed with breast or cervical cancer, or a precancerous condition of the breast or cervix, was approved on February 15, 2002, by the Centers for Medicare and Medicaid Services. The Department of Health (DOH) is the designated screening entity for the BCCPT Program.
Under Federal law, the DOH must agree that low-income women will be given priority in the provision of services. See 42 U.S.C.A. § 300n(a), regarding additional required agreements. Under its grant agreement with the NBCCEDP, the DOH HealthyWoman Project provides breast and cervical cancer screening for uninsured women who are under 65 years of age and have a household income below 250% of the Federal Poverty Income Guidelines (FPIG). Prior to the implementation of the BCCPT Program on January 1, 2002, there were no consistent avenues available to fund the ongoing treatment needs of low-income, uninsured women who were screened and diagnosed with breast or cervical cancer.
Affected Individuals and Organizations
The final-form rulemaking affects and benefits women under 65 years of age who are uninsured, who have been screened for breast or cervical cancer through the CDC NBCCEDP and have been diagnosed and found to need treatment for either breast or cervical cancer, or a precancerous condition of the breast or cervix.
There are approximately 11,600 women diagnosed with breast and cervical cancer each year in this Commonwealth (www.health.state.pa.us/stats). Census data was used to estimate the total number of the 11,600 women who are under 65 years of age and have income levels between 100% and 250% of the FPIG. The result of this analysis indicated that there are an additional 1,109 women who may be eligible for Medical Assistance each year under this option.
Accomplishments and Benefits
The final-form rulemaking will take advantage of a Federal option in the BCCPT Act that permits states to provide Medical Assistance to uninsured women under 65 years of age who have been screened for breast or cervical cancer through the CDC NBCCEDP and diagnosed and found to need treatment for either breast or cervical cancer, or a precancerous condition of the breast or cervix.
There has been no consistent avenue available to fund ongoing treatment needs of low-income, uninsured women diagnosed with breast or cervical cancer, or a precancerous condition of the breast or cervix. As a result, many women may have gone without necessary treatment that may prevent or cure their illness. This option will provide low-income, uninsured women with Medical Assistance that will enable them to seek necessary treatment, thereby decreasing the incidence of uncompensated care and this Commonwealth's cancer mortality rate.
There may be a reduction in premature mortality rates from breast and cervical cancer as a result of screening, early diagnosis and treatment. Health care providers may see a reduction in the incidence of uncompensated care for uninsured women who require treatment for breast and cervical cancer.
Fiscal Impact
The Insurance Department might realize a savings since some women determined eligible for the BCCPT Program might have been otherwise eligible for medical coverage under the adult Basic Program administered by the Insurance Department and funded by tobacco settlement funds.
Private hospitals and physicians who treat uninsured women with breast or cervical cancer, or a precancerous condition of the breast or cervix, may be compensated for services rendered.
Low-income (under 250% FPIG), uninsured women who may have otherwise incurred personal debt will realize a savings.
Paperwork Requirements
New application forms were created exclusively for use with the BCCPT Program: the PA 600B--for applications; the PA 600BP--for partial redeterminations; and the PA 600BR--for annual redeterminations. These forms have been in use since the beginning of the BCCPT Program. Each form provides instructions for use by the applicant or recipient and provider. The Department has not received adverse comments regarding these forms.
The BCCPT Program application, form PA 600B, is a two-part application used by the HealthyWoman Project and the County Assistance Office (CAO) to determine eligibility for the BCCPT Program. Part A of the application is completed at the DOH HealthyWoman Project screening site and contains demographic and income information, consent for release of information and BCCPT Program rights and responsibilities. Part B of the application is completed by the applicant, the medical provider and the CAO. Use of a single form to document demographic information needed by both programs for an eligibility determination will reduce additional paperwork for providers, applicants and the Department.
The BCCPT Program Partial Renewal, form PA 600BP, is completed at a partial redetermination of eligibility for women whose treatment for breast or cervical cancer is expected to last less than 12 months. The recipient, the medical provider and the CAO complete this form.
The BCCPT Program Annual Renewal, form PA 600BR, is completed every 12 months when continued eligibility for the BCCPT Program is redetermined. The recipient, the medical provider, the Office of Medical Assistance Programs and the CAO complete this form.
Additional information regarding the Commonwealth's BCCPT Program is in MA Bulletins 99-01-02 and 99-02-06 and Chapter 317 of the Medicaid Eligibility Handbook available on the Department's website (www.dpw. state.pa.us).
The Department includes eligibility information about the DOH HealthyWoman Program on the Department's website. A link to learn more about the DOH HealthyWoman Project, including the 250% income eligibility limit which is updated annually on the DOH website, is included on the Department's website.
Public Comment
Written comments, suggestions and objections regarding the proposed rulemaking were requested within a 30-day period following publication of proposed rulemaking. The Department received letters from the Independent Regulatory Review Commission (IRRC) and two commentators: the Pennsylvania Health Law Project (PHLP) and Community Legal Services, Inc. (CLS). In addition to providing comments on the proposed rulemaking, the PHLP stated that the BCCPT Program has been invaluable to eligible women in providing coverage for needed treatment of breast or cervical cancer, or a precancerous condition of the breast or cervix. The CLS thanked the Department for adopting the BCCPT Program.
The Department has carefully reviewed and considered each suggestion and comment and thanks the commentators.
Discussion of Comments and Major Changes
Following is a summary of the comments received within the public comment period following publication of the proposed rulemaking and the Department's response to those comments.
General--Regulations
One commentator remarked that limiting the BCCPT Program to women unconstitutionally excludes men with breast cancer.
Response
The BCCPT Act covers individuals who have been screened under the CDC breast and cervical cancer early detection program established under Title XV of the Public Health Service Act (42 U.S.C.A. §§ 300k--300n-5), which specifies ''women.'' See 42 U.S.C.A. § 1396a(aa)(3). The Department must provide Medical Assistance in accordance with the BCCPT Act.
General--Regulations
One commentator believed that limiting the program to women who are screened through the HealthyWoman Project sites creates unnecessary obstacles to accessing the BCCPT Program.
Response
The BCCPT Act specifies eligible women must be screened through the CDC NBCCEDP. CDC NBCCEDP identified the HealthyWoman Project as the accepted healthcare provider.
General--Preamble
One commentator recommended referencing sources of information such as Medical Assistance Bulletins 99-01-12 and 99-02-06 and Operations Memorandum OPS011208 in the preamble.
Response
The Department agrees in part. Information included in the Operations Memorandum has been incorporated into Chapter 317 of the Medicaid Eligibility Handbook, which is available on the Department's website (www.dpw. state.pa.us). Some information included in the nonregulatory documents has been incorporated into the final-form rulemaking. For example, the definition of ''treatment for breast and cervical cancer'' is included in § 140.702.
§ 140.602. Definitions. (redesignated as § 140.702)
§ 140.621(2)(ii). Conditions of Eligibility. (redesignated as § 140.721(2)(ii))
§ 140.633(1). Verification requirements. (redesignated as § 140.733(i))
One commentator expressed concern with the Department's use of the term ''need treatment.'' In addition, IRRC stated that the term should be edited for clarity. The PHLP commented that ''need treatment'' should be more clearly defined and it is unclear if this phrase includes taking medication designed to prevent the recurrence of cancer. The PHLP also stated that the regulation may result in different interpretations by different providers, and that ''[t]he lack of clear definition has been problematic for consumers trying to access coverage through the BCCPT.''
IRRC noted that MA Bulletin 99-01-12, effective January 1, 2002, includes a definition for ''treatment for breast or cervical cancer'' and recommends that the Department include this definition in the final-form rulemaking.
Response
The Department concurs with the commentator and IRRC and revised the regulation accordingly to include a definition for ''treatment for breast or cervical cancer'' in § 140.702. The definition includes medical services to prevent recurrence.
§ 140.621. Conditions of eligibility. (redesignated as § 140.721)
IRRC and one commentator stated that the reference to Chapter 149 (relating to citizenship and alienage) in § 140.621(1)(iii) (redesignated as § 140.721(1)(iii)) should be edited for clarity and replaced with a reference to Chapter 150 (relating to citizenship and alienage provisions for categorically needy NMP-MA and MNO-MA).
Response
The Department agrees that Chapter 149 is an incorrect reference and replaced the reference with a reference to Chapter 150.
§ 140.621(2)(iii). Conditions of eligibility. (redesignated as § 140.721(2)(iii))
One commentator suggested that stating that women must be ''uninsured'' to be eligible misleads the reader. This commentator recommended that language in the regulations pertaining to being ''uninsured'' as a condition of eligibility should be changed to ''having no creditable coverage'' and all uses of the word ''uninsured'' should be deleted.
Response
The Department agrees in part. The BCCPT Act requires that, to be eligible, women ''are not otherwise covered under creditable coverage, as defined in section 2701(c) of the Public Health Service Act (42 U.S.C.A. § 300gg(c)(1).'' The term ''uninsured'' is defined in § 140.702 as ''Having no creditable coverage as the term is defined under the Health Insurance Portability and Accountability Act (HIPAA) (Section 2701(c) of the Public Health Service Act (42 U.S.C.A. § 300gg(c)(1)).'' Because ''uninsured'' has been defined in the regulations to mean ''having no creditable coverage,'' it has not been deleted from the final-form rulemaking.
§ 140.621(2)(iv). Conditions of eligibility. (redesignated as § 140.721(2)(iv))
One commentator commented that the regulations should provide an exception that would allow BCCPT Program eligibility for women that were eligible for Medical Assistance for Workers with Disabilities (MAWD). The commentator suggested that the regulation should be changed to limit eligibility to women who are ''ineligible for any other categorically needy Medicaid program, except those charging monthly premiums, such as MAWD.''
Response
The Department disagrees. The Commonwealth provides coverage under 1902(a)(10)(a)(ii)(XVIII) of the Social Security Act, which specifies that women must not be otherwise covered under creditable coverage, as defined in HIPAA (section 2701(c) of the Public Health Service Act).
§ 140.631. Income eligibility limitations. (redesignated as § 140.731)
IRRC and one commentator recommended that this section should be edited for clarity. The commentator remarked that this section should reference the regulations or guidelines, or both, that describe the income eligibility requirements for the CDC NBCCEDP and the HealthyWoman Project. IRRC remarked that clarity would be improved by specifically identifying or including a cross-reference to where the income limits necessary to be eligible for screening by CDC NBCCEDP can be found and how an individual's income is determined.
Response
The Department disagrees with this request to include CDC NBCCEDP and the HealthyWoman Project income eligibility requirements and guidelines within the regulation. A woman who is income-eligible for CDC NBCCEDP meets the income requirements for the BCCPT Program. The Department does not do a separate determination of income eligibility. However, the DOH's income eligibility requirements can be found on the Department's website at www.health.state.pa.us.
§ 140.633(a)(2). Verification requirements. (redesignated as § 140.733(a)(2))
One commentator stated that this section should read ''[v]erification that the woman is a United States citizen, a qualified alien, or otherwise PRUCOL as defined in Chapter 150. An applicant applying for BCCPT for an emergency medical condition is not required to verify alien status.''
Response
The Department disagrees with the suggested revision. Emergency Medical Assistance and BCCPT are separate programs. Verification that an applicant is a United States citizen or a qualified alien is required for the BCCPT Program as for any other category of Medical Assistance. ''Permanently Residing Under Color of Law (PRUCOL)'' is an obsolete term. An individual who is ineligible for BCCPT because of alien status and who has an emergency medical condition may qualify for Medical Assistance for that medical emergency in accordance with § 150.11 (relating to aliens eligible for emergency medical services).
Information regarding the coverage of emergency medical conditions for undocumented aliens was not included in the regulations because it is outside the scope of Chapter 140 (relating to special MA eligibility provisions).
§ 140.641. Complete redetermination. (redesignated as § 140.741)
One commentator suggested this section should be edited for clarity and for use of consistent language.
Response
The Department agrees with the commentator's suggestion. In § 140.741, the words ''for qualified women'' have been deleted. The term ''Categorically Needy'' has been replaced with ''for all enrolled women.'' In addition, § 140.742 (relating to partial redetermination) has been revised for clarity and consistency with § 140.741.
§ 140.641(b). Complete redetermination. (redesignated as § 140.741(b))
§ 140.642(b). Partial redetermination. (redesignated as § 140.742(b))
One commentator advised that the reference to Chapter 133 (relating to redetermining eligibility) in these sections is confusing and should be edited for clarity.
Response
The Department concurs and added a cross-reference to a specific citation in Chapter 133.
§ 140.661. Eligibility begin date. (redesignated as § 140.761)
One commentator stated that this section should reference the section on retroactive eligibility by adding the following sentence to the end of this section: ''However, retroactive coverage for services may be available as allowed for by the provisions under § 140.671 dealing with Retroactive Eligibility.''
Response
The Department adopted this recommendation and a reference to retroactive eligibility has been added to this section.
§ 140.681. Reporting of changes. (redesignated as § 140.781)
IRRC and one commentator commented that this section should be edited for clarity to include, or should reference provisions that include, what changes in circumstances need to be reported and to whom the changes should be reported.
Response
The Department agrees and revised the text to provide that the recipient shall report changes to the Department that would affect eligibility as set forth in § 140.721 (relating to conditions of eligibility).
§ 140.691. Appeal and fair hearing. (redesignated as § 140.791)
One commentator stated that this section should be revised to add language to explain to which eligibility and service denials the appeal and fair hearing rights do and do not apply. Also, the commentator stated that additional guidance should be added regarding whether and how a woman can appeal HealthyWoman Project eligibility determinations.
Response
The Department disagrees that the HealthyWoman Project appeal and fair hearing information should be added to this regulation. Section 140.791 provides that the appeal and fair hearing rights under Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings) apply to eligibility determinations of the Department. This includes eligibility under the BCCPT Program. Appeals of service denials are beyond the scope of this final-form rulemaking.
Regulatory Review Act
Under section 5.1(a) of the Regulatory Review Act (71 P. S. § 745.5a(a)), on February 16, 2007, the Department submitted a copy of this final-form rulemaking to IRRC and to the Chairpersons of the House Committee on Health and Human Services and the Senate Committee on Public Health and Welfare. In compliance with the Regulatory Review Act the Department also provided the Committees and IRRC with copies of all public comments received, as well as other documentation.
In preparing the final-form rulemaking, the Department reviewed and considered comments received from the Committees, IRRC and the public. In addition to submitting the final-form rulemaking, the Department provided IRRC and the Committees with a copy of a Regulatory Analysis Form prepared by the Department. A copy of this form is available to the public upon request.
In accordance with section 5.1(j.1) and (j.2) of the Regulatory Review Act, on March 15, 2007, this final-form rulemaking was deemed approved by the Committees. IRRC met on March 15, 2007, and approved the final-form rulemaking.
Findings
The Department finds that:
(a) The public notice of intention to adopt the administrative regulations by this order has been given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2.
(b) The adoption of this final-form rulemaking in the manner provided by this order is necessary and appropriate for the administration and enforcement of the Public Welfare Code (62 P. S. §§ 101--1412).
Order
The Department, acting under the authority of sections 201(2) and 403(b) of the Public Welfare Code and Title XIX of the Social Security Act, orders that:
(a) The regulations of the Department, 55 Pa. Code Chapter 140, are amended by adding §§ 140.701, 140.702, 140.721, 140.731--140.733, 140.741, 140.742, 140.751, 140.761, 140.771, 140.781 and 140.791 to read as set forth in Annex A.
(b) The Secretary of the Department shall submit this order and Annex A to the Offices of General Counsel and Attorney General for approval as to legality and form as required by law.
(c) The Secretary of the Department shall certify and deposit this order and Annex A with the Legislative Reference Bureau as required by law.
(d) This order shall take effect upon publication in the Pennsylvania Bulletin retroactive to January 1, 2002.
ESTELLE B. RICHMAN,
Secretary(Editor's Note: For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 37 Pa.B. 1463 (March 31, 2007).)
(Editor's Note: At 34 Pa.B. 6335, these regulations were originally proposed in Subchapter D, §§ 140.601, 140.602, 140.621, 140.631--140.633, 140.641, 140.642, 140.651, 140.652, 140.671, 140.681 and 140.691. The final-form regulations now appear in Subchapter E.)
Fiscal Note: 14-490. (1) General Fund;
MA Inpatient MA Outpatient (2) Implementing Year 2006-07 is $998,000 $4,022,000 (3) 1st Succeeding Year 2007-08 is $1,260,000 $5,296,000 2nd Succeeding Year 2008-09 is $1,430,000 $6,273,000 3rd Succeeding Year 2009-10 is $1,546,000 $7,081,000 4th Succeeding Year 2010-11 is $1,672,000 $7,992,000 5th Succeeding Year 2011-12 is $1,809,000 $9,021,000 MA Inpatient MA Outpatient (4) 2005-06 Program-- $474,693,000 $945,950,000 2004-05 Program-- $531,875,000 $842,991,000 2003-04 Program-- $411,042,000 $677,979,000 (7) MA Inpatient and MA Outpatient; (8) recommends adoption. Funds have been included in the budget to cover these increases.
Annex A
TITLE 55. PUBLIC WELFARE
PART II. PUBLIC ASSISTANCE MANUAL
Subpart C. ELIGIBILITY REQUIREMENTS
CHAPTER 140. SPECIAL MA ELIGIBILITY PROVISIONS
Subchapter E. THE CATEGORICALLY NEEDY BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT PROGRAM FOR QUALIFIED WOMEN GENERAL PROVISIONS
Sec.
140.701. Policy on Medical Assistance for women with breast or cervical cancer. 140.702. Definitions. ELIGIBILITY
140.721. Conditions of eligibility. INCOME, RESOURCES AND VERIFICATION
140.731. Income eligibility limitations. 140.732. Resource eligibility limitations. 140.733. Verification requirements. REDETERMINATION
140.741. Complete redetermination. 140.742. Partial redetermination. BENEFIT COVERAGE
140.751. Benefit coverage. 140.752. Eligibility begin date. 140.771. Retroactive eligibility. REPORTING
140.781. Reporting of changes. RIGHT TO APPEAL AND FAIR HEARING
140.791. Appeal and fair hearing.
GENERAL PROVISIONS § 140.701. Policy on Medical Assistance for women with breast or cervical cancer.
The Department provides full MA benefits to uninsured women under 65 years of age who have been screened and diagnosed with breast or cervical cancer, or a precancerous condition of the breast or cervix, who are eligible under the Commonwealth's categorically needy BCCPT Program.
§ 140.702. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
BCCPT Program--Breast and Cervical Cancer Prevention and Treatment Program--A Federally-funded option that provides full MA benefits to uninsured women under 65 years of age who have been screened and diagnosed and are in need of treatment for breast or cervical cancer, or a precancerous condition of the breast or cervix. These women have been identified through an entity funded in full or in part by CDC.
CDC--Centers for Disease Control and Prevention--The lead Federal agency for protecting the health and safety of people at home and abroad by applying disease prevention and control.
NBCCEDP--National Breast and Cervical Cancer Early Detection Program--A program established by Congress under the Breast and Cervical Cancer Mortality Act of 1990 (Pub. L. No. 101-354, 104 Stat. 409) which authorizes the CDC to promote breast and cervical cancer screening and to pay for screening services for eligible individuals.
Treatment for breast and cervical cancer--Medical services, which are, or are reasonably expected to provide one of the following:
(i) Ameliorate the direct effects of breast or cervical cancer.
(ii) Aid in the clinical characterization of breast or cervical cancer, including testing for the effectiveness of curative treatment but excluding screening for recurrence or new primary cancers.
(iii) Prevent the recurrence of breast or cervical cancer.
Uninsured--Having no ''creditable coverage'' as the term is defined under the Health Insurance Portability and Accountability Act (HIPAA) (Section 2701(c) of the Public Health Service Act (42 U.S.C.A. § 300gg(c)(1)).
ELIGIBILITY § 140.721. Conditions of eligibility.
Eligibility for MA under the BCCPT Program is based on the requirements in the following chapters:
(1) A woman shall meet the following eligibility requirements:
(i) Chapter 125 (relating to application process).
(ii) Chapter 148 (relating to MA residence provisions for categorically needy NMP-MA and MNO-MA).
(iii) Chapter 150 (relating to citizenship and alienage provisions for categorically needy NMP-MA and MNO-MA).
(iv) Chapter 155 (relating to enumeration).
(v) Chapter 255 (relating to restitution).
(vi) Chapter 257 (relating to reimbursement).
(2) Under the BCCPT Program, a woman shall be:
(i) Under 65 years of age.
(ii) Screened under the CDC's NBCCEDP and diagnosed with either breast or cervical cancer, or a precancerous condition of the breast or cervix, and need treatment for either breast or cervical cancer, or a precancerous condition of the breast or cervix.
(iii) Uninsured.
(iv) Otherwise ineligible for categorically needy Medicaid as defined in § 1101.21 (relating to definitions).
INCOME, RESOURCES AND VERIFICATION § 140.731. Income eligibility limitations.
There are no income limits when determining eligibility under the BCCPT Program. An individual who meets the income limits to be eligible for screening by the CDC's NBCCEDP is income-eligible for the BCCPT Program.
§ 140.732. Resource eligibility limitations.
There are no resource limits when determining eligibility under the BCCPT Program.
§ 140.733. Verification requirements.
(a) Under the BCCPT Program, the following verification is required:
(1) Verification that the woman was screened for breast or cervical cancer, or a precancerous condition of the breast or cervix, by a provider or facility funded in full or in part by the CDC under its NBCCEDP, and diagnosed and found to need treatment for either breast or cervical cancer, or a precancerous condition of the breast or cervix. Verification of the continued need for treatment must be provided at each partial and complete redetermination.
(2) Verification that the woman is a United States citizen or qualified alien as the term is defined in 8 U.S.C.A. § 1641(b) (relating to definitions).
(3) Verification that the woman is under 65 years of age.
(4) Verification that the woman is a resident of this Commonwealth.
(5) Verification that the woman is uninsured.
(b) The verification specified in subsection (a) must be provided on a form established by the Department.
REDETERMINATION § 140.741. Complete redetermination.
(a) A complete redetermination is required at least every 12 months for women who continue to require treatment for either breast or cervical cancer, or a precancerous condition of the breast or cervix.
(b) For the BCCPT Program, the eligibility factors in § 133.84(c) (relating to MA redetermining eligibility procedures) apply.
§ 140.742. Partial redetermination.
(a) A partial redetermination is required at the end of the initial period of treatment for a woman whose initial period of treatment is expected to last less than 12 months. The initial period of treatment is based on the diagnosing or treating physician's attestation regarding the woman's diagnosis.
(b) For the BCCPT Program, the partial redetermination eligibility factors in § 133.84(d) (relating to MA redetermining eligibility procedures) apply.
BENEFIT COVERAGE § 140.751. Benefit coverage.
The Department will provide full MA coverage for a woman determined eligible under the BCCPT Program.
§ 140.761. Eligibility begin date.
The eligibility begin date is the date the woman is diagnosed with breast or cervical cancer, or a precancerous condition of the breast or cervix, but not prior to January 1, 2002. Retroactive BCCPT Program benefits are available under § 140.771 (relating to retroactive eligibility).
§ 140.771. Retroactive eligibility.
The earliest possible date for retroactive BCCPT Program benefits to begin is the first day of the third month preceding the month of application, but not prior to January 1, 2002. The period of eligibility for retroactive BCCPT Program benefits begins the first day of the month in which the first medical service was incurred if the applicant was otherwise eligible during that month.
REPORTING § 140.781. Reporting of changes.
The recipient shall report changes that would affect eligibility for the BCCPT Program under § 140.721 (relating to conditions of eligibility) to the Department within 10 days from the date of the change.
RIGHT TO APPEAL AND FAIR HEARING § 140.791. Appeal and fair hearing.
The applicant or recipient is entitled to the appeal and fair hearing rights under Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings).
[Pa.B. Doc. No. 07-837. Filed for public inspection May 11, 2007, 9:00 a.m.]
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