1. Every Womans Life PROGRAM MANUAL UPDATE 2012-2013

2. RECRUITMENT No Changes

3. RECRUITMENT ATTACHMENTS: None

4. ELIGIBILITY & ENROLLMENT Eligibility – no change Federal Poverty Guidelines – no change Client Participation Agreement – added info on What you need to know about Every Womans Life Client Transfer – no change

5. ELIGIBILITY & ENROLLMENT ATTACHMENTS: Client Participation Agreement – no change Client Transfer – no change

6. SERVICES Client Education – no change Cervical 18-39 – no change Breast 18-39 – New NCCN Breast Cancer Screening and Diagnosis Guidelines

7. SERVICES Cervical 40-64 – New USPHS Cervical Screening Guidelines Breast 40-64 – New NCCN Breast Cancer Screening and Diagnosis Guidelines

8. SERVICES Managing Abnormal Cervical – New USPHS Cervical Screening Guidelines Managing Abnormal Breast – updated NCCN version Over Age 65 – no change

9. SERVICES Rescreening – no change Referrals – no change Cancellation of Services – no change

10. SERVICES ATTACHMENTS: EWL Screening Guidelines – no change CBE Core Competencies – no change Cervical Diagnostic Guidelines – no change Breast Diagnostic Guidelines – no change QuitNow Virginia Order Form – no change

11. CASE MANAGEMENT CM for Women with Abnormal Screening Results – no change CM Needs Assessment – no change CM Care Plan – no change Tracking System – added clarification to patient confidentiality Tracking & Follow-up – added clarification for inactivating patients

12. CASE MANAGEMENT ATTACHMENTS: Needs Assessment & Care Plan – no change Tracking & Follow-up Diagram – no change

13. DATA COLLECTION, REPORTING & RETENTION Data Collection Forms – no changes to policy (Forms Changes will be discussed at the end of this presentation) Reporting Requirements – removed section on Community Health Worker Annual Work Plan Medical Record Management – no change

14. DATA COLLECTION, REPORTING & RETENTION ATTACHMENTS: Forms Changes will be discussed at the end of this presentation Monthly Screening Log – no change Match Form – no change

15. REIMBURSEMENT Reimbursement for EWL Services – added: –Clarifications on the forms needed to submit for reimbursement –Removed section on Community Health Workers –Updated the state EWL address

16. REIMBURSEMENT Changes to Federal Forms

17. REIMBURSEMENT Changes to State Forms

18. TREATMENT BCCPTA –Updated policy to include information on Project Wish

19. TREATMENT ATTACHMENTS: BCCPTA Application – no change BCCPTA Policy – no change Medicaid FAQ – Added question 22 DSS Regional Consultants – no change

20. QUALITY ASSURANCE & IMPROVEMENT Federal Performance Indicators – no change State Performance Indicators – no change

21. QUALITY ASSURANCE & IMPROVEMENT Observational Site Visit –No changes

22. QUALITY ASSURANCE & IMPROVEMENT Problem-Focused Visit –No changes

23. QUALITY ASSURANCE & IMPROVEMENT ATTACHMENTS: None

24. STAFFING EWL Provider Site Staff – removed the section on Community Health Workers Training & Technical Assistance – no changes

25. STAFFING ATTACHMENTS: None

26. EWL Data: Overview and Update Changes to the Data Forms

27. Why does EWL collect data? To monitor program –Quality Timeliness of screening to diagnosis and diagnosis to treatment… –Outcomes Number of women served, number of cancer diagnosis… –Cost Cost of screening per women served, estimated cost to serve projected number of women…

28. What does EWL do with the data? Submit to CDC in the form of MDEs –Sent to the CDC in April and October each year –Analyzed by CDC for performance indicators, trends, and missing/erroneous data Analyze for trends and problem areas –By provider site, by year, etc. Collaborate with partners to provide information and conduct research –Local universities, community organizations, other VDH agencies, other provider sites

29. How do we ensure data quality? Accurately complete all necessary fields on data forms Be aware of changes in data requirements Use the most current forms Submit data in a timely manner

30. Why are we changing the data forms….again? Reflect the new changes in the cervical guidelines To more accurately reflect the MDEs To better capture currently clinical practices To provide more accurate information to the CDC

31. Client Eligibility Form Removed the breast symptom questions from the Breast Screening and Diagnostic Form. The client self reports any abnormal breast symptoms. Change #1

32. Client Eligibility Form Removed Unknown as a choice in order to better capture race data. If a patient truly does not know their race please call the State office for guidance. Change #2

33. Client Eligibility Form *A referral includes offering clients Virginia Quit Line or other tobacco information Change #3 Check Yes even if the client refuses the referral information

34. Breast Screening and Diagnostic Form Change #1 Asterisk (*) procedures require further diagnostic evaluation Moved the breast symptom question to the Eligibility form

35. Breast Screening and Diagnostic Form Added Unilateral/Bilateral to mammogram type. Please use this box for all Diagnostic mammograms and not Additional Mammogram Views. Change #2

36. Breast Screening and Diagnostic Form Change #3 Asterisk (*) results require further diagnostic evaluation

37. Breast Screening and Diagnostic Form Change #4 Assessment is incomplete (BI-RADS 0) should only be used in instances were the radiologist/clinician does not feel comfortable determining whether there is cancer present. All other instances should use Unsatisfactory, if the film cannot be interpreted, or Unknown if the results are not known. Instances of Assessment is incomplete should have additional imaging done or a film comparison only if required by the radiologist Film comparisons as part of a routine visit should NOT be documented.

38. Breast Screening and Diagnostic Form Change #5 Added new result options for an Ultrasound to be reflect CDC data collection requirements.

39. Breast Screening and Diagnostic Form Change #6 Added the result Atypical Ductal Hyperplasia, to better reflect CDC data collection requirements

40. Breast Screening and Diagnostic Form Separated Repeat CBE from Surgical Consult for clarity. Please only use the choices under each procedure as results. Change #7

41. Breast Screening and Diagnostic Form Change #8 Added Deceased to more accurately capture data Added short-term follow up options for when clinicians/radiologists recommend short-term follow up in lieu of immediate diagnostic work. Please use the short term follow up check boxes rather than hand writing in notes.

42. Cervical Screening and Diagnostic Forms Change #1 Added 3 year (without HPV test) and 5 year (with HPV test) to the data forms to reflect the new changes in cervical guidelines.

43. Cervical Screening and Diagnostic Form Change #2 Asterisk (*) results require further diagnostic evaluation

44. Cervical Screening and Diagnostic Form Change #3 Removed Clearly defined lesion of CIN as per the CDC

45. Cervical Screening and Diagnostic Form Change #4 Added No tissue present This should only be used for ECC

46. Cervical Screening and Diagnostic Form Change #5 Added Deceased to more accurately capture data Added short-term follow up options for when clinicians/radiologists recommend short-term follow up in lieu of immediate diagnostic work. Please use the short term follow up check boxes rather than hand writing in notes.

47. These new forms will go into effect January 1, 2013.