Family and Children's Medicaid MA-3250 Breast and Cervical Cancer Medicaid
iV. bccCp screening provider procedures for bccm
A. County health departments, some community medical centers and other medical facilities that are contracted to perform screening by BCCCP will be responsible for insuring that the following forms are completed, faxed and mailed to the county dss.
REVISED 11/01/11 – CHANGE NO. 15-11
B. DMA-5087, Health Department Check List for Breast and Cervical Cancer Medicaid, is a checklist for the BCCP screening provider to use as a tool to ensure the county dss receives all the necessary information needed to determine Medicaid coverage.
C. A “Rights and Responsibilities” form is attached to the back of the DMA-5079. This form must be given to the applicant.
D. The BCCCP providers must inform the applicant that the county dss will notify her of a decision within 45 days of receipt of the application.
E. The BCCCP screening providers must use a fax cover sheet that has a statement about confidentiality if this language is not currently on the fax cover sheet. Example: This facsimile and any files transmitted with it are confidential and intended solely for the use of the individual or entity to which they are addressed. If you have received the fax in error please notify the sender, delete and destroy this message and its attachments.