BCCCNP NEW PROGRAM FORMS WEBINAR. January 8, 2019 E.J. Siegl, Program Director Breast and Cervical Cancer Control Navigation Program

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1 BCCCNP NEW PROGRAM FORMS WEBINAR January 8, 2019 E.J. Siegl, Program Director Breast and Cervical Cancer Control Navigation Program

2 NEW GRANT CHANGE IN FOCUS New Clinical Data Requirements by CDC for BCCCNP Changes Effective 1/1/19 Program Impact - Revision of BCCCNP Enrollment and Clinical forms: new data requirements - Revision of Patient Navigation forms: new data requirements - Program reimbursement for additional screening tests * new rate schedules coming out later this week * - Major changes in MBCIS with the BCCCNP module and the Patient Navigation module

3 REVISED BCCCNP CLINICAL FORMS Available at: 1. BCCCNP Enrollment Form 2. Breast and Cervical Cancer Screening Form 3. Breast Follow-up Form 4. Cervical Follow-up Form

4 REVISED BCCCNP NAVIGATION FORMS Available at: 1. Breast and Cervical Cancer Patient Screening Summary (formerly Patient Navigation form) 2. MTA Renewal Form

5 REVISED BCCCNP RATE SCHEDULES Available at: 1. FY2019 BCCCNP ~ effective 02/01/ FY2019 Codes requiring MDHHS Nurse Consultant Approval ~ effective 02/01/ One page reference document ~ effective 02/01/2019 * Note NO new ICD-10 codes have been added

6 BCCCNP ENROLLMENT FORM Two-page form: Page 1 Sociodemographic data client can complete as before Page 2 Medical History and Risk Assessment --Requires clinician review with client --Reason: To determine client breast and cervical risk and need for Screening MRI or annual Pap test --BCCCNP can reimburse for longer office visit needed to perform risk assessment

7 BCCCNP ENROLLMENT FORM Two-page form: Page 1 Sociodemographic data - Page 2 Medical History and Risk Assessment Changes to Page 1 Barrier Assessment useful in assessing problems a woman may encounter that prevents her from getting a mammogram Gender Identity optional How client learned about BCCCNP optional

8 ENROLLMENT FORM PAGE 1 Required Sections to Complete 1. Client Contact Information bolded areas are required * 2. Race and Ethnicity 3. # Household members/income 4. Insurance Information (if applicable) (need front and back copy of insurance card) 5. Barriers (optional) completion may help in addressing problems with obtaining mammograms

9 QUESTION???? We print off the socio-demographic information on BCCCNP clients from our EHR, do we still have to complete the Enrollment Form? Answer: No. As long as you can get the required information from your EHR, you can just send the EHR data.

10 BCCCNP ENROLLMENT FORM PAGE 2 Medical History and Risk Assessment WHAT s NEW? Breast Cancer Risk: Identifying risk factors for reimbursing Screening MRIs for women at increased risk for breast cancer preapproval required Cervical Cancer Risk Assessment: Identifying risk factors for reimbursing early Pap tests

11 ENROLLMENT FORM PAGE 2 Required Sections to Complete 1. Breast Cancer Risk 2. Cervical Test History 3. Cervical Cancer Risk 4. Tobacco History (changed from smoking history)

12 NOTE: Personal history of breast cancer does not require screening MRI.

13 DOES BREAST DENSITY PLAY A FACTOR IN DETERMINING SCREENING RECOMMENDATIONS? The NCCN, USPSTF, ACS, ACOG, ACR do not recommend routine supplemental screening for women with dense breasts without other risk factors Supplemental screening has not been shown to result in a decrease in mortality. If supplementary screening is desired, preliminary evidence suggests that MRI is more sensitive than ultrasound for cancer detection.

14 BOTH SCREENING AND DIAGNOSTIC MRI S REQUIRE PRE-APPROVAL BY MDHHS NURSE CONSULTANT PRIOR TO SCHEDULING What information is required for pre-approval of MRI s? Client Age Screening MRI s Client Risk Factor(s) Risk Assessment Model Score (if performed) Previous imaging (mammograms/ MRIs performed in past) Client Age Diagnostic MRI s CBE or Mammogram Abnormality indicating need for MRI Past Biopsy history or history of abnormal mammograms Will need results of MRIs after performed

15 Who is responsible for asking the breast risk assessment questions? QUESTION? Answer: Any BCCCNP staff member or clinic staff can ask the question. BUT, if a woman identifies any risk factor from the list or states she has a family history of breast cancer then a health care provider needs to make the final determination of actual risk

16 BCCCNP WILL REIMBURSE FOR EXTENDED OFFICE VISITS TO PERFORM DETAILED BREAST RISK ASSESSMENT 99204: New Patient, comprehensive history, exam, moderate complexity decision making; 45 minutes 99205: New Patient, comprehensive history, exam, high complexity decision making; 45 minutes 99215: Established Patient, Full Exam, 40 minutes

17 BCCCNP IS UNABLE TO REIMBURSE FOR: Genetic counseling BRCA testing Genetic Panel testing

18 QUESTIONS ABOUT BREAST RISK ASSESSMENT?

19 CERVICAL TEST HISTORY AND CERVICAL CANCER RISK ASSESSMENT

20 Who is responsible for asking the cervical risk assessment questions? QUESTION? Answer: Any BCCCNP staff member or clinic staff can ask the question. BUT, if a woman identifies any risk factor from the list then a health care provider needs to make the final determination of actual risk

21 QUESTIONS ABOUT CERVICAL CANCER RISK ASSESSMENT?

22 BREAST AND CERVICAL CANCER SCREENING FORM WHAT S NEW? BREAST Exam and Screening 1. CBE results are now 2 categories only: -- Normal/Benign and -- Abnormal Exam (Suspicious for cancer) 2. Breast Cancer Screening Indication for Exam has new options: -- Normal options to choose will be Screening or Diagnostic -- Other options if client is referred from outside provider or does not receive mammogram 3. Screening MRI Results (for high risk women) are now required Abnormalities suspicious for cancer are bolded and are to be marked for Immediate Follow-up

23 BREAST AND CERVICAL CANCER SCREENING FORM WHAT S NEW? CERVICAL Cancer Exam and Screening 1. Pelvic exam results options: cervix present or absent 2. Cervical Cancer Screening Indication for Exam has 2. new options: -- Normal options to choose will be Screening or Surveillance (previously follow-up Pap) -- Other options if client is referred from outside provider or does not receive Pap test or Pap performed after HPV 3. HPV test indications for exam: -- Reflex (HPV performed after Pap test) separate date -- HPV Test Results: Positive results separated by genotyping for 16 or 18 Abnormalities suspicious for cancer are bolded and are to be marked for Immediate Follow-up

24 QUESTION? DO WE NEED TO USE THIS FORM IF WE RECEIVE ACTUAL IMAGING/PATHOLOGY RESULTS? Answer: No Clinical data to be sent to agency can include either: Completed Breast and Cervical Screening Form (if results have been already interpreted by a clinician) OR Copies of clinician notes for CBE/Pelvic Exam and actual copies of Mammogram, MRI, Pap test, and HPV test results.

25 QUESTIONS ABOUT OBTAINING SCREENING RESULTS

26 BREAST FOLLOW-UP FORM 1. Format changes 2. Addition of Diagnostic MRI results added as follow-up to an abnormal mammogram or US (pre-approval required) 3. Pre-approval required prior to enrolling ANY client under age 40 with an abnormal breast exam. 4. Final diagnosis required; additional information if cancer diagnosed.

27 CERVICAL FOLLOW-UP FORM 1. Format Changes 2. Addition of HPV test results to form NOTE: HPV ordered as Screening or Co-test with a Pap test for women ages will be denied reimbursement 3. Final diagnosis required; additional information if cancer diagnosed.

28 WHAT INFORMATION DO WE SEND TO MDHHS? Completion of breast/cervical follow-up forms - optional HOWEVER, ALL RESULTS MUST BE SENT TO AGENCY/MDHHS UNLESS OTHERWISE STATED. THIS INCLUDES: ALL IMAGING (MAMMOGRAM, US, MRI) ALL PATHOLOGY (PAP TEST, HPV TESTS) ANY DIAGNOSTIC PROCEDURES/BIOPSIES ALL PROVIDER NOTES REGARDING EXAMS/TESTS

29 QUESTIONS ABOUT BREAST AND CERVICAL FOLLOW-UP FORMS

30 NAVIGATION FORMS Forms need to be completed ONLY by agencies providing services to insured Navigation-Only clients or MTA clients DO NOT use these forms for BCCCNP clients receiving reimbursed services through the program!

31 BREAST AND CERVICAL PATIENT SCREENING SUMMARY (FORMERLY PATIENT NAVIGATION) Form to be completed on: NEW navigation-only clients enrolled after 1/1/2019 Clients enrolled in MTA from outside BCCCNP DO NOT complete this form on currently enrolled MTA clients renewing coverage

32 WHAT S NEW? Results of Mammogram, HPV test, and Pap test Status of Diagnostic Services (completed or not) Final Diagnosis (if diagnostics performed) 2-PAGE FORM NOW 1 PAGE Treatment start date (if cancer diagnosed) How treatment paid (client insurance or client enrolled in MTA)

33 Other changes: Definition of contact For clinic patients at health department 1 st contact is date of office visit 2 nd contact, with client s permission, may be any variety of ways (I.e. voice mail message left, letter, , etc.) Information to collect at FIRST CONTACT Client Contact information Race & Ethnicity BARRIERS at least one Barrier must be checked- if no barriers identified, client not eligible for navigation services

34 PERMISSION TO OBTAIN TEST RESULTS NEW: CLIENT SIGNATURE NEEDED ON FORM On-site Clinic Patients Discuss need to obtain results at time of office visit Depending on your clinic s informed consent you may not need to have this form signed Off-Site Patients Need to discuss how patient will benefit from your help What s in it for them? (I.e. gas card, transportation services, help in scheduling appts., etc.)

35 SECOND CONTACT Obtain test results Is diagnostic follow-up is needed? Yes, assist with arranging follow-up No, navigation is complete

36 BEFORE SENDING PATIENT SCREENING SUMMARY FORM TO MDHHS IS THE FOLLOWING COMPLETED? Date of 1 st and 2 nd client contact Client Contact information Box checked that client has signed the Agreement to Obtain Test Results Form --Copy of form to be sent with Patient Screening Summary. If client is an agency clinic patient then form does not need to be signed. State client is clinic patient in comments section above navigator name. Race and Ethnicity Barriers Identified (At least one barrier MUST be checked) Results of mammogram/pap/hpv tests Date of Diagnostic Services Completed (if applicable) Navigation Complete Navigator Name and date

37 QUESTIONS ABOUT PATIENT SCREENING SUMMARY

38 MTA CLIENT RENEWAL NEW FORM: Complete ONLY on MTA clients RENEWING coverage Complete all bolded information under Contact Information Answer all questions under Verification of Client Eligibility Check appropriate boxes if referrals were made for the client. Sign the form and date when the form is faxed to MDHHS.

39 QUESTIONS ABOUT MTA CLIENT RENEWAL

40 CONTACT INFORMATION: SAM BURKE TORY DONEY E.J. SIEGL