PROVIDER ORIENTATION

National BCCEDP  Money appropriated by congress to CDC in 1991 (public law )  CDC awards grants to 50 states, District of Columbia, 5 U.S. Territories and 12 tribal organizations - five year term

National BCCEDP Since 1991, the NBCCEDP has: Served 4.2 million women and provided 10.4 million screening exams Diagnosed 54,276 breast cancers, 144,460 pre-malignant cervical lesions, and 3,113 invasive cervical cancers

NBCCEDP Conceptual Framework

Virginia Every Woman’s Life Program

Every Woman’s Life Mission To provide high-quality breast and cervical screening, diagnostic and health services to low-income, uninsured women in the most cost efficient manner.

Every Woman’s Life Program Organizational Chart Every Woman's Life Christina Benton MPH Cancer Control Supervisor Vacant Quality Control Coordinator (Data Manager)a Shourilu Nagandla Data Entry Clerk Beth Miller Admistrative Assitant Jewel Wright MPH Comprehensive Cancer Coordinator Vacant Clinical Coordinator

Every Woman’s Life Staff Cancer Control Supervisor- provides leadership and oversight for all program components of the EWL and the comprehensive cancer program. Comprehensive Cancer Control Coordinator- builds partnerships to reduce the cancer burden in the state through networking, and participation on coalitions, committees, and conferences on the local, state, and national level. Clinical Coordinator - oversees the case management and quality assurance and improvement components of the program.

Every Woman’s Life Staff Quality Control Coordinator (Data Manager) - manages the data reporting and collection system known as CaST. Data Entry Clerk – assists the Quality Control Coordinator with data and reporting needs. Administrative Assistant - performs a variety of program support tasks to coordinate and support the daily operations of the EWL team.

Virginia’s Comprehensive Cancer Control Program VACCP works with local communities through pooled resources to: –Promote healthy lifestyles and recommended cancer screenings –Educate people on cancer symptoms –Increase access to quality cancer care –Enhance cancer survivors’ quality of life

EWL Administrative Provider Sites 2014

Women Age Federal

Eligibility Criteria Uninsured or underinsured Virginia women who have income at or below 200% of the Federal Poverty Level (FPL)

Priority Population Women over age 50 Never or rarely screened for cervical cancer Less than 100% of the FPL Minority women

Never/Rarely Screened Defined as women who have never had a Pap test, or who have not had one in 5 years or more Goal (20% of new enrollees)

Client Participation Agreement Clients must read and sign Agreement Defines the client’s responsibility Kept in patients chart for observational audits Does not need to be turned into state office

What A Client Can Expect Provide brochure “What You Need to Know About Every Woman’s Life” –Explains importance of screening –What screening services are available –What happens if additional tests are needed, etc.

Client Education Culturally and linguistically appropriate Importance of regular screenings Other age appropriate screenings Information to encourage a healthy lifestyle

Breast Services Women Age Clinical Breast Exam Screening Mammogram Self-Breast Exam Demonstration

Cervical Services Women Age Cervical Cytology Screening (Pap Test)/HPV Test Pelvic Exam

Cervical Cytology Intervals The screening interval for cervical cancer screening is every three years with cytology alone or every five years with cytology and HPV testing (co- testing).

Hysterectomy Reason for hysterectomy determines need for cervical screening Hysterectomy performed for cervical neoplasia (precursors to cervical cancer) or invasive cervical cancer – cervical screening needed Hysterectomy for other non-cancer gynecological reasons –cervical screening not needed

Re-Screening Services Women Age Return Visit – At Least Months Apart Services - CBE - Screening mammogram - Pelvic exam - Pap test/HPV Test, when indicated Follow-Up & Tracking Inactivate, when indicated

Client Referrals For women – set screening mammogram appointment Provide referrals or appointments for diagnostic procedures Provide referral to QuitNow phone line to tobacco users Provide other medical, social and supportive referrals

Women Age STATE

Eligibility Criteria Uninsured or underinsured Virginia women who have income at or below 200% of the Federal Poverty Level (FPL)

MUST BE SYMPTOMATIC

Client Participation Agreement Clients must read and sign Agreement Defines the client’s responsibility

Client Education Culturally and linguistically appropriate Age appropriate screenings Information to encourage a healthy lifestyle Other health education information

Cervical Services Women Age Cervical diagnostic services for abnormal cervical result of (in order of priority): –Squamous Cell Carcinoma –Atypical Glandular Cells (AGC) –High-Grade SIL (HSIL) –Atypical Squamous Cells - Cannot Exclude High Grade Squamous Intraepithelial Lesion (ASC-H)* –Atypical Squamous Cells – Cannot Exclude High Grade SIL (ASC:H) and High Grade Squamous Intraepithelial Lesion (HSIL) in women –Low-Grade Squamous Intraepithelial Lesion (LSIL) for women with no HPV test or +HPV* –Atypical Squamous Cells of Undetermined Significance (ASCUS) with +HPV* –Women age 30 and older with a negative cytology screening result and +HPV 16/18 –Women age 30 and older with an unsatisfactory screening result and +HPV

Breast Services Women Age Breast diagnostic services for symptoms of:  Discrete Palpable Mass  Bloody or Serous Nipple Discharge  Nipple or Areolar Scaliness  Breast Skin Dimpling, Retraction or Inflammation Self-referred clients will need clinical breast exam

Breast Services Women Age Diagnostic services for abnormal breast imaging result of: Screening Mammogram or Ultrasound - BIRADS 5 – Highly suggestive of malignancy - BIRADS 4 – Suspicious abnormality

Breast Services Women Age Do not cover routine breast screening for this age group, even if the woman is high-risk:  Personal/family history  Test positive for BRCA1 or 2  First degree relative with breast cancer

Breast & Cervical Services for Women Age 65 and Older Encourage enrollment into Medicare Not Medicare eligible - client may be enrolled into EWL Submit as a state screen Women 65 and over are NOT eligible for Medicaid Treatment Act

Client Referrals Provide referrals or appointments for diagnostic procedures Provide referral to QuitNow phone line to tobacco users Provide other medical, social and supportive referrals

Clinical Algorithms

Abnormal Screening Result BREAST NCCN Breast Cancer Screening and Diagnosis Guidelines, 2013 – CERVICAL ASCCP Guidelines 2013 –

Medical Advisory Committee

Medical Advisory Committee: –Composed of clinical experts –Review guidelines annually –Consultation on special cases –Recommend professional development topics/strategies

Case Management

Two Purposes: 1)Identify client barriers 2)Overcome client barriers RESULT Women receive timely and appropriate diagnostic and treatment services

Case Management Major Components include: Assessment Planning Service Coordination Monitoring Advocacy/Self Sufficiency Evaluation

Tracking System The system must be able to: Track client’s receipt of screening and diagnostic services Ensure confidentiality (this includes ing EWL patient information) Be effective

Tracking & Follow-Up NOTIFICATION: –Normal Screening Results –Abnormal Screening Results FOLLOW-UP –Diagnostic Services –Rescreening

Core Performance Indicators

Clinical Indicators Work Up Completed Timeliness from Screening to Diagnosis Timeliness from Diagnosis to Treatment Treatment Started

Recruitment Indicators Mammograms over age 50 Never/Rarely Screened for Cervical Cancer Rescreen (non-core) Very Low-Income Women (non-core) Minority Women (non-core)

Quality Assurance

 Monitoring Quality –Track core performance indicators –Analyze client/program data –Conduct regular site visits –Providers internal QA processes

Observational Site Visit Routine – every two years Purpose: –Assess accessibility and quality of services provided –Evaluate clinic flow and efficiency –Compare actual care to outcomes reported Provide technical assistance & solicit feedback

Problem-Focused Site Visit Specific problem identified Team approach Action plan developed Progress tracked

Data Collection and Reporting

Data Collection Eligibility Form Breast Screening and Diagnostic Form Cervical Screening and Diagnostic Form

Data Collection Information from EWL data forms is used to track provider performance and compliance with CDC standards.

Data Collection Must record all screening tests and results plus any diagnostic procedures and results and work- up for each client.

Reporting Requirements Monthly Screening Log Annual Renewal Application Annual Matching Funds Report

Breast & Cervical Cancer Prevention & Treatment Act Effective July 2001

Treatment Coverage Medicaid coverage for full range of services that Medicaid covers (begins first day of application month) Covered for the duration of treatment Co-pay for services (e.g., $1.00 clinic visit; $ inpatient hospital stay)

Retroactive Coverage Medicaid will cover costs for all services (covered by Medicaid) incurred during the retroactive period Period begins three months prior to the month of application or the month the woman first received an EWL service

Who is Eligible for the Treatment Act Virginia resident Women age Screened/diagnosed through EWL In need of treatment

Who is Eligible for the Treatment Act U.S. Citizens Qualified Aliens (depends on arrival date into US, work history and other factors)

Who is Eligible for the Treatment Act Women that do not have creditable health insurance

Who is Eligible for the Treatment Act Women diagnosed with breast/cervical cancer or pre-cancer through another state/program and relocate to Virginia before or during treatment.

Who May Be Eligible Women who receive SSI Women that are pregnant Women that have a child under the age of 18 living with them May be eligible for another Medicaid covered group – refer to DSS office for evaluation

Who is Not Eligible Women who have received a final diagnosis for breast or cervical cancer/pre-cancer and were not screened and/or diagnosed by an EWL Provider

Who is Not Eligible Women Age 65 and Older Incarcerated Women –Not eligible until release

General Rule Many factors effect Medicaid eligibility If unsure, complete application and refer to local DSS office for determination

Medicaid Application Process Complete Medicaid Form –2-page short form –Coordinator/Case Manager must sign and date –Client must sign Send completed form to local DSS office

Notification Process DSS will notify client –DSS will not notify EWL provider Decision not made within 10 days - DSS must contact client

Notification Process For eligibility information: OR (Must have Medicaid provider number to access the system)

Provider’s Role Coordinator/Case Manager must: Ensure treatment is started Re-enroll client when treatment ends

Redetermination DSS will re-determine Medicaid eligibility annually Re-Determination Form is available at local DSS office EWL does not complete the Re- Determination Form

Reimbursement

Capitation Rate FEDERAL $320 ($350-NOVA) Per Woman/Per Year

To Receive Payment Perform all required screening procedures (Pap test, pelvic, CBE, Mammogram) Minimum - At least a mammogram Complete all data forms (includes screening and diagnostic results) –Of allowable procedures

To Receive Payment Complete invoice List women served with federal funds on appropriate Client Screening List Attach completed client data forms Mail to state EWL office Must submit original invoice

Payment Denied Payment for a client will be denied if: Client not eligible for services Data related to eligibility (age, income) is missing Screening mammogram not performed (unless client enrolled for diagnostic procedures only)

Payment Denied Payment for a client will be denied if:  Duplicate payment  90 day rule (invoice submitted 90 days after the date of last screening exam)

Capitation Rate STATE $400 ($440 – NOVA) Per Woman/Per Year

To Receive Payment Perform diagnostic tests Complete diagnostic section on the Screening and Diagnostic Form

To Receive Payment Complete invoice List women served with state funds on appropriate Client Screening List Attach completed client data forms Mail to state EWL office Must submit original invoice

Payment Denied Payment for a client will be denied if:  Client not eligible for services  Data related to eligibility (age, income) is missing  Duplicate Payment

IMPORTANT RESPOND TO ALL REQUESTS FOR MISSING DATA IN A TIMELY MANNER

Important! MEET YOUR AWARD ALLOCATION

OTHER

Professional Development Focused on provider site staff and clinicians Topics identified by needs & interests Methods: –Conference calls –Web casts –Blast s –Opportunities linked from EWL website

What We Provide YOU Technical Assistance Resources –Client Educational Brochures –Outreach Brochures Policy Manual

Ordering Materials Publication Order Form Minimum order amount on all items Maximum amount on some items

Toll Free Line EWL-4YOU ( )