Section 120.500 Health Benefits for Persons with Breast or Cervical Cancer

Section 120

Section 120.500  Health

Benefits for Persons with Breast or Cervical Cancer

a)         A person shall be eligible for medical assistance if the

person meets the following eligibility requirements under Health Benefits for

Persons with Breast or Cervical Cancer (BCC):

1)         Cooperates in establishing eligibility as described in Section

120.308.

2)         Meets citizenship/immigration status as described in Section

120.310.

3)         Meets residency requirements as described in Section 120.311.

4)         Assigns rights to medical support and collection of payment as

described in Section 120.319.

5)         Furnishes a Social Security number as described in Section

120.327.

6)         Is under the age of 65 years.

7)         Has been screened for breast or cervical cancer under the

National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

administered by the Illinois Department of Public Health (IDPH) as described in

subsection (c) of this Section, and has been found to need treatment, as

defined in subsection (d) of this Section, for breast or cervical cancer or a

precancerous condition as defined in subsection (e) of this Section.

8)         Continues to need treatment as defined in subsection (d) of

this Section.

9)         Is uninsured, that is, must not have creditable coverage, as

defined under the Health Insurance Portability and Accountability Act, for

breast or cervical cancer treatment.

b)         A person shall not be determined eligible for Health Benefits

for Persons with Breast or Cervical Cancer:

1)         if, upon screening by the Department, the person is found to

be otherwise eligible for medical assistance under Section 120.11, 120.20 or

120.30 without a spenddown; or

2)         if the person is in a correctional facility pursuant to 42 CFR

435.1008

ancer treatment.

b)         A person shall not be determined eligible for Health Benefits

for Persons with Breast or Cervical Cancer:

1)         if, upon screening by the Department, the person is found to

be otherwise eligible for medical assistance under Section 120.11, 120.20 or

120.30 without a spenddown; or

2)         if the person is in a correctional facility pursuant to 42 CFR

435.1008.

c)         A person shall meet the screening requirement if:

1)         the person's breast or cervical cancer screening was conducted

within the scope of a grant, sub-grant or contract under the NBCCEDP

administered by IDPH; or

2)         beginning

September 1, 2006, the person's diagnosis of breast or cervical cancer or

precancerous cervical condition was confirmed by an entity receiving a grant,

sub-grant or contract under the NBCCEDP administered by IDPH.

d)         A person shall be considered to need treatment if, in the

opinion of the person's treating physician, the person requires therapy directed

toward cure or palliation of breast or cervical cancer, including recurrent

metastatic cancer that is a known or presumed complication of breast or

cervical cancer and complications resulting from the treatment modalities

themselves.  Treatment includes diagnostic services that may be necessary to

determine the extent and proper course of treatment.  Persons who require only

routine monitoring services (for example, pap smears or mammograms) are not

considered to need treatment.

e)         For the purposes of this Section, a precancerous condition

means:

1)         Cervical intraepithelial neoplasia, grade III (CIN III);

2)         Severe dysplasia of the cervix;

3)         High-grade squamous intraepithelial lesion (HGSIL); or

4)         Atypical glandular cells of undetermined significance (AGUS)

with a suspicion of adenocarcinoma in situ.

f)         All assets shall be exempt from consideration in determining

eligibility under this Section

s:

1)         Cervical intraepithelial neoplasia, grade III (CIN III);

2)         Severe dysplasia of the cervix;

3)         High-grade squamous intraepithelial lesion (HGSIL); or

4)         Atypical glandular cells of undetermined significance (AGUS)

with a suspicion of adenocarcinoma in situ.

f)         All assets shall be exempt from consideration in determining

eligibility under this Section.

g)         A person's eligibility for medical assistance under this

Section shall be terminated when the person no longer meets the requirements of

this Section.

h)         Application Process

1)         The process of applying for medical assistance shall be

initiated by the submission to the Department, by an entity designated by IDPH,

of a statement certifying that a person meets the condition of eligibility

described in subsection (a)(7) of this Section.

2)         The Department shall contact the person by telephone, mail or

other appropriate means to complete an application.

3)         The application date shall be the date a signed application is

received in the Department's central breast and cervical cancer eligibility

unit.

4)         Application may be made by additional methods that the

Department establishes.

5)         Applications shall meet all requirements found at 89 Ill. Adm.

Code 110.10(a), (c), (e) and (i).

6)         A BCC application is only an application for Health Benefits

for Persons with Breast or Cervical Cancer.

i)          Authorization of Medical Assistance Eligibility

1)         Eligibility will be effective no earlier than the third month

before the month of application if the applicant would have been eligible if he

or she had applied.  In no case shall eligibility be effective prior to July 1,

2001, for persons meeting the screening requirement described in subsection

Breast or Cervical Cancer.

i)          Authorization of Medical Assistance Eligibility

1)         Eligibility will be effective no earlier than the third month

before the month of application if the applicant would have been eligible if he

or she had applied.  In no case shall eligibility be effective prior to July 1,

2001, for persons meeting the screening requirement described in subsection

(c)(1) of this Section, or prior to September 1, 2006, for persons meeting the

screening requirement described in subsection (c)(2) of this Section.

2)         Eligibility can begin no earlier than the following:

A)        for persons meeting the screening requirement described in

subsection (c)(1) of this Section, the month in which the applicant was

screened as described in subsection (a)(7) of this Section; or

B)        for

persons meeting the screening requirement described in subsection (c)(2) of

this Section, the month in which the applicant received the test or procedure

that resulted in a diagnosis of breast or cervical cancer or one of the

precancerous cervical conditions described in subsection (e) of this Section.

j)          Persons enrolled in Health Benefits for Persons with Breast

or Cervical Cancer shall be exempt from Sections 102.210 and 102.230.

k)         Persons enrolled in Health Benefits for Persons with Breast or

Cervical Cancer who enter a nursing facility must provide income information

sufficient for the Department to calculate a group care credit, as established

in Sections 120.40 and 120.60, except that assets shall not be counted.  The

Department will not pay for nursing facility services for any person who

refuses to provide the required information.

l)          Persons applying for or enrolled in Health Benefits for

Persons with Breast or Cervical Cancer shall be entitled to appeal rights as

described at 89 Ill. Adm. Code 102.80-83.