Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
		MassHealth
		All Provider Bulletin 129
		December 2003

	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Acting Commissioner

	RE:	MassHealth Breast and Cervical Cancer Treatment Program

Background	Effective January 1, 2004, the Division of Medical Assistance (Division) has expanded its benefits to women diagnosed with breast or cervical cancer.  These women must have been diagnosed through a federally funded screening program that is operated in Massachusetts by the Department of Public Health Women’s Health Network (WHN) and meet other MassHealth eligibility requirements.

	Please see Transmittal Letter ALL-121 for revisions to the Division’s administrative and billing regulations.

MassHealth Coverage	Generally, members eligible under this expansion will be able to receive MassHealth Standard benefits through enrollment in the Division’s Primary Care Clinician (PCC) Plan.  All members eligible under this expansion are covered for medically-necessary services listed in 
130 CMR 450.150(H)(3).  Applicants who do not meet MassHealth Standard citizenship requirements may still be eligible for MassHealth Limited.

Other Health Insurance	By federal law, women covered under this expansion must be
Coverage	uninsured or must not otherwise have “creditable coverage” for treatment of breast or cervical cancer.  A woman is not considered to have “creditable coverage” when she is in a period of exclusion for treatment of breast or cervical cancer, she has exhausted her lifetime limit on all benefits under her plan, including treatment for breast or cervical cancer, or she has limited-scope coverage (e.g., covered only for dental, vision, or long-term-care) or coverage only for a specified disease.  In addition, a woman who is an American Indian or Alaska Native who is provided care through a medical-care program of the Indian Health Service or of a tribal organization is not considered to have “creditable coverage.”

	

Attached Information	The Division has included with this bulletin an information sheet that 
Sheet	describes the eligibility requirements for women who have been diagnosed with breast or cervical cancer through the Women’s Health Network.  If you know of individuals who might be eligible for these benefits, please encourage them to seek screening services through the Women’s Health Network.  The Department of Public Health WHN can be reached at 1-877-414-4447 (TTY:  617-624-5992 for people with partial or total hearing loss).

Questions	Applicants or members wanting additional information may contact the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 
1-800-497-4648 for people with partial or total hearing loss).

	MassHealth-participating providers who want to enroll as PCCs in order to deliver primary care to members diagnosed with breast or cervical cancer may contact MassHealth Provider Enrollment and Credentialing at 617-576-4424 or 1-800-322-2909.