program description established by: national breast and cervical cancer early detection program...

Program Description• Established by:• National Breast and Cervical Cancer Early

Detection Program (NBCCEDP)• Colorectal Cancer Control Program (CCRP)

Goals• Promote breast, cervical and colorectal cancer

screening and early detection• Provide access to quality breast, cervical and

colorectal cancer screening services

Federal LawsBreast and Cervical Cancer Mortality Prevention

Act of 1990 • Established the NBCCEDP

Breast and Cervical Cancer Prevention and Treatment Act of 2000 • Established State treatment programs through

Medicaid

State Laws • Early Detection of Breast and Cervical Cancer

Screening Program – Medical Advisory Committee – RCW 43.70.655

• Related RCWs• 74,04.050, 74.04,055, 74.04.057, 74.08.090, 74.08.090,

74.04.050, 74.04.057, 74.09.530, 74.09.510

State Rules• Washington Administrative Codes (WAC)• Breast and Cervical Cancer Treatment

Program (BCCTP) - WAC 182-505-0020• Alien Emergency Medical (AEM) Program

(WAC 388-424-0001 & 388-424-0006)

2012-2013 Funding Sources

Funding Breast/Cervical

Amount

Federal BCHP 4.3 millionState 2.8 millionSusan G Komen for the Cure Affiliates

1.4 million

Total B/C 8.5 millionFunding ColorectalFederal CRC- screening 607,489Combined Total 9,107,489

Prime Contractors• Citrine Health, Inc.• PeaceHealth Southwest Medical Center• Public Health Seattle & King County Health Department• Spokane Regional Health District• Wenatchee Valley Medical Center• Yakima Health District

Public Health Seattle-King

County

Yakima Health District

Wenatchee Valley

Medical Center NW

Spokane Regional Health District

Breast, Cervical and Colon Health Program Service Delivery Network Map 2012-2013

PeaceHealth Southwest Medical Center

Whatcom Okanogan Ferry Stevens Pend Oreille

Spokane

LincolnDouglas

Grant

Kittitas

Chelan

Snohomish

King

Pierce

Lewis

Pacific

Grays Harbor

Jefferson

Clallam

Adams Whitman

Garfield

AsotinColumbia

Walla Walla

Franklin

BentonYakima

KlickitatSkamania

Cowlitz

Clark

Wahkiakum

Thurston

Mason

Skagit

San Juan

Island

Kitsap

Citrine Health

Breast Health Services for Women

Age Presentation Income Services Covered40-64 Well woman

Breast cancer symptomsBreast cancer findings

< 250% FPL251% - 300% FPL – available in most counties

Breast cancer screening & diagnostics

18-34 Breast cancer findings(i.e. suspicious CBE)

< 300% FPLavailable in most counties

Follow-up CBEBreast cancer diagnostics

35-39 Breast cancer symptoms < 250% FPL251% - 300% FPL – available in most counties

CBEBreast cancer diagnostics

65+ Well woman Breast cancer symptomsBreast cancer findings

<250% FPLNot eligible for Medicare

Breast cancer screening & diagnostics

Cervical Health Services for Women

Age Presentation Income Services Covered40-64 Well woman

Cervical cancer symptomsCervical cancer findings

< 250% FPL Cervical cancer screening & diagnostics

35-39 Breast cancer symptoms

<250% FPL Cervical cancer screening & diagnostics

65+ History cervical cancer findings(CIN2, CIN3)

<250% FPLNot eligible for Medicare

Cervical cancer screening & diagnostics for 20 years after pre cancer diagnosis

Colon Health Services for Men and Women

Age Presentation Income Services Covered50-64 Asymptomatic &

Average RiskIncreased Risk

<250% FPL Colon cancer screening or surveillance & diagnostics

18-49 Asymptomatic & Increased Risk due to personal or family history

<250% FPL Colon cancer screening & diagnostics

65-75 Asymptomatic &Average RiskIncreased Risk

<250% FPLNot eligible for Medicare

Colon cancer screening & diagnostics

Priority Populations• Native Americans/Alaska

Natives• Asian and Pacific

Islanders• Hispanics• Lesbian and Bisexual• People with disabilities

• Women who have never been screened for breast or cervical cancer

• Men 50+ for CRC

Breast & Cervical Cancer Treatment• Breast & Cervical Cancer Treatment Program

(Medicaid – comprehensive)• Alien Emergency Medical (AEM) Program

(Medicaid) - limited care only

Colorectal Cancer Treatment

• No specific program for colorectal cancer treatment

• Referred to charity care and other organizations that may assist in paying for treatment

Reimbursement• Prime Contractors sub-contract with many providers in

their region• Reimbursement is paid at the highest Medicare allowable

rate regardless of location• Reimbursement is specific to breast, cervical and colon

cancer screening and diagnosis• CDC limits some reimbursement rates• CDC and BCCHP/MAC determine what procedures we can

reimburse

Program Screens FY12• 14,916 screened for breast and cervical cancer• 1439 screened for colorectal cancer, 30 suspicious

polyps removed

2013 Legislative session• Assumption with HCR that all clients will be eligible for

the exchange or expansion• Governor’s budget eliminates state funding for our

program by 2016• Phased out reduction plan for state funds:• 28% FY 14• 70% FY 15

• Federal budget unknown

Health Reform Impact• Technically:• 70% of current clients will be eligible for

Medicaid expansion (at 138% FPL or less)• 30% of current clients will be eligible for

the exchange (above 139% FPL)

Health Reform Impact• What we know:• 10% of eligible state population may not

get insurance due to financial hardship

Health Reform -- Planning • Community Health Worker Training System• Partnership with HCA• Connecting clients to services• Playing the waiting game

Megan Celedonia, MES

Manager, BCCHP

Megan.celedonia@doh.wa.gov

360 236-3785

Megan Celedonia, MES

Manager, BCCHP

Megan.celedonia@doh.wa.gov

360 236-3785