Women's Cancer Screening Program Information for Healthcare Providers
The Rhode Island Women's Cancer Screening Program (WCSP) provides no-cost pelvic exams, Pap tests, HPV tests, clinical breast exams, and mammograms (breast x-rays) to eligible Rhode Island women. The program also covers many diagnostic tests.more
Patient Enrollment, Screening, and Referral
Eligible women must be enrolled in the WCSP at a participating provider office. New enrollment forms should be completed at the office visit every year when women are screened. If a client is new to your facility, have her complete an enrollment form. (This helps the Women's Cancer Screening Program track clients through the screening and follow-up process.) Each participant must be enrolled in the Women's Cancer Screening Program at a participating provider office before she is given a referral for a mammogram. The bottom line: When in doubt, enroll!
For age-eligible and income-eligible women, we can fund:
At the office visit, a women's health exam may include a Pap test, pelvic exam, HPV test, and a clinical breast exam. Once enrolled, a woman can be given a referral for a mammogram. All Rhode Island radiology facilities participate in the WCSP.
Use your office name or office stamp on WCSP Enrollment and Screening Forms to indicate where the client was enrolled into the WCSP. The RED "WOMEN’S CANCER SCREENING PROGRAM" stamp must be placed on the Pap smear/ HPV requisitions, mammogram referrals, or other outside orders so that the lab or radiology facility will invoice the WCSP and not the client for services provided.
Reimbursable versus non reimbursable services
To find out if a CPT is reimbursable, refer to the Provider Reimbursement Schedule Current | Dates of Service October 1, 2018 – December 31, 2018
- Breast Cancer Screening for Women at High-Risk- The Women’s Cancer Screening Program reimburses for annual Screening Breast Magnetic Resonance Imaging (MRI) performed in conjunction with an annual mammogram for clients with any one of the following risk factors:
- Personal history of BRCA1 or BRCA2 gene mutations
- First-degree relative (parent, brother, sister or child) with a BRCA1 or BRCA2 gene mutation but not having had genetic testing themselves
- First-degree relative with premenopausal breast cancer
- Lifetime risk of breast cancer of ≥20% according to risk assessment tools based on family history (e.g. Tyrer-Cuzick, Claus, BRCAPRO, BOADICEA)
- Radiation therapy to the chest between ages of 10-30
- Breast MRI can also be reimbursed when used to better assess areas of concern on a mammogram or for evaluation of a client with a past history of breast cancer after completing treatment.
- Endometrial biopsies are reimbursable in the following situations:
- Initial workup of a Pap test result of Atypical Glandular Cells (AGC).
- The Pap test of a postmenopausal woman shows endometrial cells.
Restrictions on Reimbursable Services
Pap tests following hysterectomy: The Women's Cancer Screening Program cannot reimburse for cervical cancer screening in women with total hysterectomies (i.e., those without a cervix) unless the hysterectomy was performed because of cervical neoplasia (precursor to cervical cancer) or invasive cervical cancer, or if it was not possible to document the absence of neoplasia or reason for the hysterectomy.
- Breast density alone is not an indication for breast MRI under current guidelines. Screening Breast MRI performed in conjunction with a mammogram is reimbursable for women who have been determined to be at high-risk for breast cancer (see above high-risk definition).
- Breast MRI cannot be reimbursed when used to assess the extent of disease for staging in women who were recently diagnosed with breast cancer and preparing for treatment.
- Treatment of breast cancer, cervical intraepithelial neoplasia, and cervical cancer. Please note: Coverage for the cost of treatment may be available through the Rhode Island Medical Assistance program (see below).
Treatment through the Medical Assistance Program
As an extension of the Women's Cancer Screening Program, women may be eligible to apply for Medical Assistance (Medicaid) to cover the cost of treatment for a precancerous condition of the breast/cervix or a diagnosis of breast or cervical cancer. In order to qualify for Medical Assistance through the Women's Cancer Screening Program, a woman must:
Meet the eligibility requirements for enrollment in the Women's Cancer Screening Program.
Be a US citizen (and show proof) or be a qualified immigrant for a minimum of five years (and provide a copy of her permanent resident alien card). Please note: a working VISA or a copy of a social security card is not considered proof of permanent resident alien status.
Show proof of Rhode Island residency (driver's license, utility bill, etc.).
Have no other individual or group insurance. Please note: Women with Medicare part A and/or B are not eligible for Medical Assistance through the WCSP.
What You Should Do
Help clients apply for Medical Assistance using the one-page form created specifically for the treatment component of the WCSP. Only complete a Medical Assistance application when a client has been recommended to have treatment procedures for:
Cervical cancer or a precancerous cervical condition (e.g., LEEPs, Cones, hysterectomy, etc.).
Breast cancer or a precancerous breast condition (e.g., all surgical, stereotactic, and ultrasound guided biopsies, etc.).
Complete a Verification of Need form for clients.
Gather copies of the client's proof of citizenship, proof of Rhode Island residency, and Social Security card, if available.
Complete, date, and sign DHS form DHS-922.
Mail original copies of these forms and copies of supporting documents to the Case Management Coordinator at the Rhode Island Department of Health. For help with this process, please call 401-222-1151.
Contact the Women's Cancer Screening Program to order additional forms.
What We Will Do
As soon as all required forms are received, the WCSP Case Management Coordinator will meet with a representative from the Department of Human Services to determine eligibility (usually within 7 days of receipt of completed application). The Case Management Coordinator will call the provider site that initiated enrollment to let them know if the patient is enrolled in Medical Assistance and the effective date of enrollment. The WCSP fiscal staff will contact each provider site that has submitted invoices to the WCSP to inform them of the client's Medical Assistance coverage for any pending payments.
Duration of Eligibility for Medical Assistance
A woman with a pre-cancerous condition of the breast or cervix is eligible for Medicaid services for 4 months. A woman with a diagnosis of breast or cervical cancer is eligible for Medicaid services for one year. Prior to the end the woman’s eligibility period, the Department of Human Services will send the woman a re-determination letter.
If she continues to need treatment for a precancerous condition of the breast or cervix, or breast or cervical cancer, she must have her provider complete the re-determination form and return it to Department of Human Services. If the provider confirms that treatment is needed, Department of Human Services will extend the Medical Assistance benefit until the woman completes treatment or has access to other health insurance coverage. This process will continue as long as she needs treatment, as verified by a clinician.
During her eligibility period, a woman is entitled to the full scope of services available through Medical Assistance. In other words, coverage is not limited to treatment of a pre-cancerous condition or diagnosis of cancer. A woman will not be removed from Medical Assistance without prior correspondence from the Department of Human Services office.