Revision 25-3; Effective Sept. 1, 2025

Mailing Address

Breast and Cervical Cancer Services (BCCS) Program
North Austin Complex, Mail Code 0224
4601 W. Guadalupe Street
Austin, TX 78751-2920

Helpline

8 a.m. to 5 p.m. Central Time
Monday through Friday
Austin Phone No. 512-776-7796

Email

• BCCSProgram@hhs.texas.gov
• Med-ITHelpdesk@hhs.texas.gov
• FCS_Contracts@hhs.texas.gov
• FCS_Finance@hhs.texas.gov

Fax

512-776-7203

Website(s):

• Breast and Cervical Cancer Services
• Healthy Texas Women Breast and Cervical Cancer Services Provider Resources

Revision 23-2; Effective Sept. 29, 2023

The Breast and Cervical Cancer Services (BCCS) Policy Manual is a guide for grantees who deliver BCCS services in Texas. The manual has been structured to provide grantees with information needed to comply with program requirements.

BCCS is authorized by federal law 42 USC Section 300k--300n-5 through the Centers for Disease Control and Prevention (CDC) by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

Federal Medicaid law gives states the option to provide Medicaid assistance to women who were screened through the Centers for Disease Control and Prevention’s (CDC) NBCCEDP and found to have breast or cervical cancer. [See 42 United States Code Section1396a(aa).]

We acknowledge the Centers for Disease Control and Prevention, for its support of the Texas staff, and the printing and distribution of the monograph under cooperative agreement NU58DP007140 awarded to Texas. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

Texas provides Medicaid coverage to eligible women diagnosed with breast or cervical cancer by a BCCS program grantee. In 2007, the 80th Texas Legislature adopted Human Resources Code Section 32.024 (y-1) authorizing any health care provider to refer eligible women in need of treatment for breast or cervical cancer to Medicaid. Effective Sept. 1, 2007, any woman diagnosed with breast or cervical cancer that meets all eligibility requirements, as determined by BCCS policy for Medicaid for Breast and Cervical Cancer (MBCC), may receive Medicaid services.

1210 Compliance

Revision 23-2; Effective Sept. 29, 2023

Federal and state laws about reporting abuse, operation of health facilities, professional practice, insurance coverage and similar topics also impact women’s health services. Grantees are required to be aware of, and comply with, current laws.

Title XIX – Medicaid (Title XIX of the Social Security Act) was created by Congress in 1965. All organizations that receive BCCS funding are required to be enrolled providers of services to Medicaid-eligible women and men. (Federal regulation: Title XIX, Social Security Act, [42 USC Section1396-1396v et. seq.] Grants to States for Medical Assistance Programs).

Texas Human Resources Code Section32.024(c-1)

1220 Program Description, Rules and Funding

Revision 25-3; Effective Sept. 1, 2025

BCCS provides access to quality breast and cervical cancer screening and diagnostic services to women with low incomes.

Grantees must provide or assure the provision of required services per Texas Administrative Code (TAC), Title 26, Part 1, Chapter 371.9-11 and the program rules and the requirements established in the Program Policy Manual. Requirements outlined in the Program Policy Manual are subject to change with advance notice from System Agency.

Find the state rules for program services at Texas Administrative Code (TAC), Title 26, Part 1, Chapter 371.

Funding

BCCS services are funded by a federal CDC cooperative agreement, federal Temporary Assistance for Needy Families (TANF) to Title XX funds, and State General Revenue.

1230 Definitions

Revision 25-3; Effective Sept. 1, 2025

The following words and terms are used in this manual per these definitions.

Adjusted Gross Household Income - The gross household income before taxes, minus any allowable deductions. The adjusted gross household income is used to calculate the Federal Poverty Level (FPL) percentage.

Alternate Eligibility Screening Tool (AEST) - An HHSC-approved eligibility screening form substitute, such as in-house form or electronic form, that contains the required information for determining eligibility.

Applicant – A person who applies to receive services, including a current client who applies to renew.

Barrier to Care – A factor that hinders a person from receiving health care. For example, distance, lack of transportation, documentation requirements and copayment amount.

Breast and Cervical Cancer Services (BCCS) – A program administered by HHSC that provides breast and cervical cancer screening services to low-income, uninsured and underinsured women.

Centers for Disease Control and Prevention (CDC) – Federal agency responsible for protecting the health and safety of all Americans and for providing essential human services.

Cervical Dysplasia Management and Treatment Services – Management and treatment services provided to women with biopsy-confirmed cervical dysplasia (CD).

Client – A person who has been screened and determined to be eligible for the program.

Confidentiality – The state of keeping information private and not sharing it without permission.

Consultation – A type of service provided by a health care provider with expertise in a medical or surgical specialty. Who, upon request of another appropriate health care provider, assists with the evaluation, management, or both of a client.

Cost Reimbursement – The basis for reasonable, allowable, and allocable Grant Project direct costs.

Covered Service – A medical procedure that the program reimburses a health care provider for.

Diagnosis – The recognition of disease status determined by evaluating the history of the client and the disease process, and the signs and symptoms present. Determining the diagnosis may require some or all the following:

• Microscopic (culture)
• Chemical (blood tests)
• Radiological examinations (X-rays)

Diagnostic Services – Activities related to the diagnosis made by a physician or other health professional.

Diagnostic Studies or Diagnostic Tests – Tests ordered by the client’s health care practitioners to evaluate a client’s health status for diagnostic purposes.

Disease Surveillance – Periodic monitoring for disease progression to quickly identify and treat pre-cancerous and cancerous conditions.

Dual-Eligible – Eligible for programs that provide the same or similar services.

Eligibility Date – Date the grantee or program administrator determines a person becomes eligible for the program.

Eligible Immigrant – A qualified immigrant who lives in the United States with 40 qualifying quarters, if five years have passed since the legal date of entry, per Texas Administrative Code (TAC), Title 1, Part 15, Chapter 366, Subchapter D. The applicant must meet the residency standards per TAC, Title 1, Part 15, Chapter 366.407.

Federal Poverty Level (FPL) – The set minimum amount of income a family needs for food, clothing, transportation, shelter and other necessities. In the United States, this level is determined by the Department of Health and Human Services. FPL varies by family size. The number is adjusted for inflation and reported annually in the Federal Poverty Guidelines. Public assistance programs, such as Medicaid, define eligibility income limits in terms of a percentage of FPL.

Fee-for-Service – Payment mechanism for services that are reimbursed on a set rate per unit of service, also known as unit rate.

Fiscal Year (FY) – The state fiscal year is Sept. 1 through Aug. 31.

Good Faith Effort – Making at least three documented attempts to obtain treatment or navigate clients with a pre-cancerous or cancerous breast or cervical diagnosis who do not meet the eligibility criteria for either BCCS Cervical Dysplasia, Medicaid for Breast and Cervical Cancer (MBCC) or both.

Grantee –A non-state entity that receives an award directly from the state awarding agency to carry out an activity under a state program. The term grantee does not include subgrantees.

Gross Household Income - The total countable income of the household before taxes.  (For descriptions of countable income refer to the Texas Works Handbook).

Health and Human Services Commission (HHSC) – The Texas administrative agency established under Chapter 531, Texas Government Code, or its designee. HHSC manages programs that help families with food, health care, safety and disaster services.

Health Care Provider – A physician, physician assistant, nurse practitioner, clinical nurse specialist, certified nurse midwife, federally qualified health center, family planning agency, health clinic, ambulatory surgical center, hospital ambulatory surgical center, laboratory or rural health center.

Health Service Region (HSR) – Counties grouped within specified geographic service areas throughout the state. Refer to Texas Public Health Regions on the Texas Department of State Health Services (DSHS) website.

Household – A person who lives alone or a group of two or more people related by birth, marriage, including common law marriage, or adoption, who live together and who are legally responsible for the support of the other person. Unborn children should also be included. Treat applicants who are 18 years old as adults.

Informed Consent – A health care provider makes sure the benefits and risks of a diagnostic or treatment plan, the benefits and risks of other appropriate options, and the benefits and risks of taking no action are explained to a client.  They do this in a way that is understandable to that client and allows the client to participate and make sound decisions about their own medical care.

In-reach – Activities conducted to inform and educate existing clients within an organization about services they do not receive but may be eligible to receive.

Medicaid – The Texas Medical Assistance Program, a joint federal and state program provided in Texas Human Resources Code Chapter 32 subject to Title XIX of the Social Security Act, 42 U.S.C. Section 1396. Reimburses for health care services delivered to low-income clients who meet eligibility guidelines.

Medicaid for Breast and Cervical Cancer (MBCC) – Medicaid program that provides access to cancer treatment services for qualified women.

Med-IT® – Medical Information Tracking System.

Minimum Data Elements (MDE) – A set of standardized data elements used to collect demographic and clinical information on women screened with NBCCEDP funds.

Minor – Per the Texas Family Code, a minor is person younger than 18 years who is not and has not been married or who has not had the disabilities of minority removed for general purposes, such as emancipated

National Breast and Cervical Cancer Early Detection Program (NBCCEDP) – A federal program administered by the CDC that awards funds to Texas BCCS and other state and tribal grantees. The program helps women who are low-income, uninsured, and underserved gain access to screening for early detection of breast and cervical cancer.

Outreach – Activities conducted to inform and educate the community about services and increasing the number of clients served.

Patient Navigator- A person who provides individualized assistance to clients to eliminate barriers to timely care across all segments of the health care continuum. This includes application assistance for Healthy Texas Women Fee-for-Service, Family Planning Program (FPP), and Breast and Cervical Cancer Services (BCCS) programs.

Point of Service – Location where a person can receive services.

Quality Assessment (QA) – The measurement of the level of quality at a given point in time.

Quality Improvement (QI) – The commitment and approach used to improve the process continuously with the intent of meeting and exceeding set expectations and outcomes.

Quality Monitoring – The planned, systematic and ongoing collection, compilation and organization of data about the quality or appropriateness of an important aspect of care and the comparison of those data to an established level of performance.

Referral – The process of directing or redirecting, such as a medical case or a person, to an appropriate specialist or agency for information, help or treatment.

Subgrantee – A non-state entity that receives a subaward from a pass-through entity to carry out part of a state program but does not include an person that is a beneficiary of such a program. A subgrantee may also be a grantee of other state awards directly from a state awarding agency. A subgrantee may also be referred to as a subrecipient. (TxGMS, Appendix 2, p 57).

Telemedicine – A health care service delivered by a physician licensed in this state or by a health professional who acts under the delegation and supervision of a physician licensed in this state and acts within the scope of their license to a client at a different physical location than the physician or health professional who uses telecommunications or information technology.

Texas Resident – A client who lives within the geographic boundaries of Texas.

Underinsured – A person whose health insurance does not fully cover screening and diagnostic services.

Unduplicated Client – Clients enrolled in BCCS are counted only one time during the program’s fiscal year, regardless of the number of visits, encounters or services they receive. For example, one person seen four times during the year is counted as one unduplicated client.

1240 Acronyms

Revision 22-0; Effective August 15, 2022

Revision 23-2; Effective Sept. 29, 2023

The grantee must ensure clients are provided services in a timely and nondiscriminatory manner. The grantee must adhere to the following guidelines:

• have a policy in place that delineates the timely provision of services;
• provide services to people deemed eligible as soon as possible and no later than 30 days from the initial request;
• maintain reasonable clinic and reception room wait times that do not present a barrier to care;
• comply with all applicable civil rights laws and regulations outlined in 2320, Nondiscrimination;
• have a policy in place that requires qualified staff to assess and prioritize a client’s needs;
• provide referrals for people that cannot be served, or cannot receive a specific service;
• manage funds to ensure established clients continue to receive services throughout the budget year, including after allocated funds are expended;
• inform people of program services and encourage them to bring required documentation to the initial visit for eligibility processing; and
• have policies to identify and eliminate possible barriers to care.

Revision 24-2; Effective Sept. 20, 2024

Grantees must comply with state laws that govern the reporting of suspected abuse and neglect of children, adults with disabilities or people 65 years or older. Grantees and providers must develop policies and procedures that follow the reporting guidelines and requirement in Human Resources Code, Chapter 48 which requires suspected abuse, neglect or exploitation of an elderly person, a person with a disability or a person receiving services from certain home and community-based providers to be reported.

Reporting an Abuse Emergency

To report an emergency that involves the abuse or neglect of children, adults with disabilities, people 65 years or older, or a person receiving services from certain home and community-based providers, call the Texas Abuse Hotline at 800-252-5400. For cases that pose an imminent threat or danger to the client, call 9-1-1 or any local or state law enforcement agency.  

Reporting a Suspicion of Abuse

For situations that do not require immediate investigation and to report suspicions of abuse, neglect and exploitation of children, adults with disabilities, people 65 years or older, or a person receiving services from certain home and community-based providers, use the Department of Family and Protective Services Texas Abuse Hotline.

2210 Human Trafficking

Revision 25-3; Effective Sept. 1, 2025

Grantees must comply with all state and federal anti-trafficking laws, including the Trafficking Victims Protection Act of 2000, Texas Occupations Code Sections 116.002 and 116.003. This requires health practitioners to complete an HHS-Approved Human Trafficking Course for every licensure renewal period.

Grantees must display signage about human trafficking in areas where clients and the public can easily see them. This includes lobbies, waiting rooms, front reception desks, and locations where people apply for and receive services.

Grantees must have a written policy on human trafficking, which includes:

• the definition of human trafficking;
• how to identify possible situations of human trafficking;
• the screening tool used to identify possible situations of human trafficking;
• what to do and who to report to if human trafficking is suspected;
• mandatory reporting of suspected child human trafficking;
• victim support resources; and
• annual staff training.

Resources for Human Trafficking Policy Development

• Texas Health and Human Services Human Trafficking Resource Center
• Texas Health and Human Services Health Care Practitioner Training Page
• Human trafficking into and within the United States: A review of the literature on human trafficking in the U.S. for the U.S. Department of Health and Human Services
• Resource Library on the National Human Trafficking website
• Rescue and Restore Campaign by the U.S. Department of Health and Human Services
  • Contains multiple resources for health care providers, social service personnel and law enforcement for identifying and aiding trafficking victims.
  • Includes slide presentations for training purposes.

2220 Domestic and Intimate Partner Violence (IPV)

Revision 25-1; Effective Feb. 4, 2025

Intimate partner violence (IPV) describes physical, sexual or psychological harm by a current or former partner or spouse. Per Texas Human Resources Code, Chapter 51, family violence may also include emotional harm and a threat of harm. IPV can exist regardless of the presence of sexual intimacy.

Health care professionals and organizations must adhere to reporting requirements in the Texas Family Code, Chapter 91.

Grantees also must have a written policy about assessment and prevention of domestic and intimate partner violence. The policy must include the provision of annual staff training.

Revision 24-2; Effective Sept. 20, 2024

2310 Confidentiality

Revision 25-3; Effective Sept. 1, 2025

Grantees must comply with the U.S Health Insurance Portability and Accountability Act of 1996 (HIPAA) established standards for privacy protection. The HIPAA Privacy Rule requires grantees to develop and distribute a notice that provides a clear explanation of privacy rights and practices. This Notice of Privacy Practices must be given to clients, at the first appointment, upon request, and at a minimum, every three years. The notice must be posted in a clear and easy to find location for clients to review. It also must be posted on the organization’s website. More information on health information privacy is on the U.S. Department of Health and Human Services Notice of Privacy Practices website and Notice of Privacy Practices for Protected Health Information website.

Grantees must make sure all employees and volunteers receive training about client confidentiality during orientation and be made aware that violation of the law about confidentiality may result in civil damages and criminal penalties. A health care provider’s staff, paid and unpaid, must be informed during orientation of the importance of keeping client information confidential. All employees, volunteers, subrecipient, board members and advisory board members must sign a confidentiality statement during orientation.

A grantee must document the client’s preferred method of communication, such as cell phone, email, work phone or text, and preferred language in the client’s record. Each client must receive verbal assurance of confidentiality. Clients must be told that confidentiality means information is kept private and not shared without permission. They also must be told about any applicable exceptions such as abuse reporting. Grantees are required to provide clients with a copy of the signed confidentiality policy or agreement and maintain a copy in the client's record. Grantees must not require consent for services from the spouse of a married client.

2320 Nondiscrimination and Limited English Proficiency

Revision 25-3; Effective Sept. 1, 2025

HHSC contracts require grantees to comply with state and federal antidiscrimination laws including state rules in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 395, Subchapter B, Section 395.11.

Find more information about nondiscrimination laws and regulations on the HHSC Civil Rights Office website and the Requirements for Contractors website.

Contract Terms and Conditions

To ensure compliance with nondiscrimination laws, regulations and policies, grantees must:

• sign a written assurance to comply with applicable federal and state nondiscrimination laws and regulations;
• have a written policy that states the agency does not discriminate based on:
  • race;
  • color;
  • national origin including limited English proficiency (LEP);
  • sex;
  • age;
  • religion; or
  • disability;
• have a policy that addresses client rights and responsibilities that is applicable to all people who request services;
• have procedures to notify the HHSC Civil Rights Office of any program- or service-related discrimination allegation or complaint no more than 10 calendar days after the allegation or complaint;
• make sure all grantee staff are trained in the grantee's nondiscrimination policies, including policies for serving people with LEP and people with disabilities, and HHSC complaint procedures;
• notify all people who apply for services of the grantee's nondiscrimination policies and complaint procedures; and
• prominently display civil rights posters in common areas, including lobbies and waiting rooms, front reception desks and locations where clients apply for services. Posters are on the Civil Rights Office website.

Direct questions about this section and civil rights matters to the HHSC Civil Rights Office.

LEP

To comply with civil rights requirements related to LEP, grantees must:

• take reasonable steps to make sure people with LEP have meaningful access to its programs and services;
• not require a person with LEP to use friends or family members as interpreters;
  • a family member or friend may serve as a person’s interpreter if the person requests it; and
  • the family member or friend does not compromise the effectiveness of the service or violate client confidentiality; and
• make people with language service needs, including people with LEP and disabilities, aware that the grantee will provide an interpreter free of charge.

2330 Termination of Services

Revision 24-2; Effective Sept. 20, 2024

A grantee must never deny services to an eligible client because of an inability to pay. Grantees have the right to terminate services to a client if:

• they are disruptive, unruly, threatening or uncooperative to the extent the client seriously impairs the grantee’s ability to effectively and safely provide services; or
• their behavior jeopardizes their own safety, or the safety of clinic staff or others.

A client has the right to appeal the denial, modification, suspension or termination of services. See 2340, Resolution of Complaints.

Grantees must have a written policy related to termination of services. For more information, see the Fair and Fraud Hearings website.

2340 Resolution of Complaints

Revision 24-2; Effective Sept. 20, 2024

Grantees must make sure clients can express concerns about care received and that those concerns are handled in a consistent manner. A grantee’s policy must explain the process to follow if the client is not satisfied with the care received. This process must include:

1. Grantees must investigate and resolve a concern within 30 business days after the grantee receives the concern.
2. Clients may contact a grantee’s clinic to see if the clinic can explain the decision or correct the problem.
3. If a client remains unsatisfied with how the concern was handled, grantee may encourage the client to send an email to BCCSProgam@hhs.texas.gov.
4. Grantees must provide the client with contact information to the HHS Office of the Ombudsman.
5. All concerns must be documented in the client’s record.

2350 Reserved for Future Use

Revision 24-2; Effective Sept. 20, 2024

2360 Freedom of Choice

Revision 22-0; Effective August 15, 2022

Clients have the right to choose health care providers, without coercion or intimidation. Acceptance of health care services does not preclude eligibility for, or receipt of, any other service or assistance.

2370 Research (Human Subject Clearance)

Revision 23-2; Effective Sept. 29, 2023

To participate in proposed research that would involve the use of BCCS clients as subjects, the use of BCCS clients’ records or any data collected from BCCS clients, BCCS grantees must get prior approval from their own internal Institutional Review Board (IRB) and from HHSC. For information about the process, grantees should visit the Institutional Review Board Home.

The grantee must have a policy in place that indicates that prior approval will be obtained from HHSC before instituting any research activities. The grantee must also ensure that all staff are made aware of this policy through staff training. Documentation of training on this topic must be maintained. Federal BCCS funds may not be used for research.

Revision 24-2; Effective Sept. 20, 2024

Grantees must obtain the client’s written, informed and voluntary general consent to receive services before they receive any clinical services per applicable state and federal law. A general informed consent explains the types of services provided and how client information may be shared with other entities for reimbursement or reporting purposes. If a person does not receive services for a period of three years or more, a new general consent must be signed before beginning delivery of services.

Consent information must be effectively communicated to every client in an understandable manner. This communication must allow the client to participate, make sound decisions about their own medical care, and address any disabilities that impair communication in compliance with LEP regulations. Only the client who receives services may give consent. When the client is legally unable to consent, a parent, in the case of an unemancipated minor, or court-appointed legal guardian must consent on the client’s behalf. Consent must never be obtained in a manner that could be perceived as coercive.

Also, as described below, the grantee must obtain informed consent of the client for procedures per the Texas Medical Disclosure Panel.

Clients who enter BCCS for services must also sign consent that authorizes the grantee to enter or view client protected health information in the statewide Med-IT® database. If this statement is not included in the general consent, an additional consent must be developed for the client to sign and included with the general consent in the client health record.

HHSC grantees should consult a qualified attorney to determine the appropriateness of all consent forms used by their health care agency.

2410 Texas Medical Disclosure Panel Consent

Revision 24-2; Effective Sept. 20, 2024

Grantees must obtain the client’s informed consent for procedures per the Texas Medical Disclosure Panel (TMDP). The Texas Legislature established TMDP to:

• determine which risks and hazards related to medical care and surgical procedures health care providers or physicians must disclose to their clients or people authorized to consent for their clients; and
• establish the general form and substance of such disclosure. TMDP developed a list of procedures that require full and specific disclosure, List A, for certain procedures. More information is on the TMDP webpage and in the Civil Practice and Remedies Code, Chapter 74.102.

For all other procedures not on List A, the physician must disclose through a procedure-specific consent all risks that a reasonable client would want to know. This includes all risks that:

• are inherent to the procedure, one which exists in and is inseparable from the procedure itself, and
• could influence a reasonable person’s decision to consent to the procedure.

Revision 25-3; Effective Sept. 1, 2025

Grantees must have an organized and secure client record system. The grantee must make sure the record is organized, readily accessible and available to the client upon request with a signed release of information. Records must be kept confidential, secure and:

• safeguarded against loss or use by unauthorized people;
• secured by lock when not in use and inaccessible to unauthorized people; and
• maintained in a secure environment in the facility, as well as during transfer between clinics and between home and office visits.

The client’s written consent is required to release personally identifiable information, except as may be necessary to provide services to the client or as required by law, with appropriate safeguards for confidentiality. HIV information must be handled per law. Refer to the DSHS HIV/STD Program Laws, Rules, and Authorization webpage for more information.

When information is requested, grantees should release only the specific information requested. Information collected for reporting purposes may be disclosed only in summary, statistical or other form that does not identify clients. Providers must give clients transferring to other providers, upon request, a copy or summary of their record to expedite continuity of care. Electronic records are acceptable as medical records.

Grantees, providers and subrecipients must maintain all records that pertain to client services, contracts and payments for the period specified by HHSC. Requirements about time limits for submitted claims are in  TAC Title 1, Part 15, Chapter 354, Section 354.1003. Requirements for medical record maintenance are in TAC Title 22, Part 9, Chapter 163. Grantees must follow contract provisions, maintain medical records for at least seven years after the contract closes, and follow the retention standards of the appropriate licensing entity. All records about services must be accessible for examination at any reasonable time to HHSC representatives and as required by law.

2510 Personnel Policy and Procedures

Revision 25-3; Effective Sept. 1, 2025

Grantees must develop and maintain personnel policies and procedures to ensure all staff are hired, trained, and evaluated appropriately for their job position. Personnel policies and procedures must include:

• job descriptions;
• a written orientation plan for new staff to include skills evaluation and competencies appropriate for the position; and
• a performance evaluation process for all staff.

Job descriptions, including those for contracted personnel, must specify required qualifications and licensure. All staff must be appropriately identified with a name badge.

Grantees must designate:

• one (1) Medicaid for Breast and Cervical Cancer (MBCC) point-of-contact with responsibilities to provide training and technical help to staff helping with and submitting MBCC applications; and
• one (1) Evidence-Based Intervention (EBI) point-of-contact with responsibilities to oversee and support HHSC BCCS-sponsored and clinic-level EBI projects. The EBI contact is responsible for providing training and technical assistance to staff implementing EBI projects. The EBI contact, or a designee, is required to attend EBI-specific meetings and webinars.

Grantees must show evidence employees meet all required qualifications and receive required annual training. Job evaluations should include observation of staff and client interactions during clinical, counseling and educational services.

Grantees must establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain. All employees and board members must complete a conflict-of-interest statement during orientation. All medical care must be provided under the supervision, direction and responsibility of a qualified medical director. The medical director must be a licensed Texas physician.

Grantees must establish, annually review, and train staff on BCCS program requirements and policies, including any updates to the Program Policy Manual and required forms that occur during the Grant Term.

Grantees must have a documented plan for organized staff development. There must be an assessment of:

• training needs;
• quality assurance indicators; and
• changing regulations and requirements.

Staff development must include orientation and in-service training for all personnel and volunteers. Nonprofit entities must provide orientation for board members and government entities must provide orientation for their advisory committees. Employee orientation and continuing education must be documented in agency personnel files.

Whether positions are funded under this grant or not, grantees must notify HHSC in writing, within 30 calendar days of any change in:

• any grant-funded positions;
• Chief Executive Officer (CEO), Chief Financial Officer (CFO), program director or program manager;
• MBCC point-of-contact; and
• EBI point-of-contact.

Grantees must ensure that at least one representative with capabilities and responsibility to disseminate information to program administrative and clinic staff:

• attends a minimum of two priority technical assistance webinars offered by HHSC during the fiscal year. These specific webinars are identified as mandatory or priority in HHSC’s electronic mail. To receive credit for participating, attendees must follow HHSC’s directions including completion of any sign-in sheet, registration, or survey within the specified time frame; and
• has access to the HHSC’s web-based applications on the SharePoint site. The grantee must sign and submit a Family Clinical Services Extranet and Data Upload Security Agreement form for each grantee staff person accessing HHSC’s SharePoint site. Grantees must ensure users of HHSC’s SharePoint site have an Outlook or Microsoft Office 365 account.

Revision 24-2; Effective Sept. 20, 2024

2610 Facilities and Equipment

Revision 25-3; Effective Sept. 1, 2025

Grantees must:

• Maintain a safe environment and have appropriate exterior signage to identify funded entity as a health care facility.
• Provide clean and well-maintained facilities where services can be delivered with space for exam rooms, client intake, waiting areas and space for clinical and administrative staff.
• Have written policies and procedures that address the handling of hazardous materials, fire safety and medical equipment.

Hazardous Materials

Grantees must have written policies and procedures that address:

• the handling, storage and disposal of:
  • hazardous materials and waste per applicable laws and regulations;
  • chemical and infectious waste, including sharps; and
• an orientation and education program for personnel who manage or have contact with hazardous materials and waste.

Fire Safety

Grantees must have a written fire safety policy that includes a schedule for testing and maintenance of fire safety equipment. Evacuation plans for the premises must be clearly posted and visible to all staff and clients.

Medical Equipment

Grantees must have a written policy and maintain documentation of the maintenance, testing and inspection of medical equipment, which includes an automated external defibrillator (AED). Documentation must include:

• assessments of the clinical and physical risks of equipment through inspection, testing and maintenance;
• reports of any equipment management problems, failures and user errors;
• an orientation and education program for personnel who use medical equipment; and
• manufacturer recommendations for the care and use of medical equipment.

Radiology Equipment and Standards

All facilities that provide radiology services must:

• possess a current Certificate of Registration from the Department of State Health Services Radiation Control Program;
• comply with Title 25, Texas Administrative Code, Chapter 289, Texas Regulations for Control of Radiation; and
• post Notice to Employees, Texas Regulations for Control of Radiation (PDF).

Refer to the Texas Department of State Health Services, Radiation Control Program for information on X-ray machine registration.

Smoking and Vaping Ban

Grantees must have a written policy that prohibits smoking and vaping in any portion of their indoor facilities. If a grantee subcontracts with another entity to provide health services, the subgrantee must comply with this policy.

Disaster Response Plan

Grantees must have written and verbal plans that address how staff are to respond to emergency situations such as fires, flooding, power outages and bomb threats. The disaster plan must identify the procedures and processes to be initiated during a disaster and the staff position responsible for each activity. A disaster response plan must be in writing, formally communicated to staff and kept in the workplace available to employees for review. An employer with 10 or fewer employees may communicate the plan to them verbally.

Refer to the Help for Employers | OSHA.gov | Occupational Safety and Health Administration for more resources on facilities and equipment.

Clinical Emergencies

Grantees must adequately prepare to handle clinical emergency situations. Each site must:

• have a written plan for the management of on-site medical emergencies, emergencies that require ambulance services and hospital admission.
• have staff trained in basic cardiopulmonary resuscitation (CPR) and emergency medical action. Staff trained in CPR must be present at all hours of clinic operations.
• maintain emergency resuscitative drugs, supplies and equipment appropriate to the services provided at that site and appropriately trained staff when clients are present.
• maintain documents in personnel files that confirm staff are trained in the written plans or protocols.

Suicide Prevention

Grantees must display signage related to suicide prevention, including the 988 Suicide and Crisis Lifeline. This signage must be displayed in areas where clients and the public can easily refer to them, such as lobbies, waiting rooms, front reception desks and locations where people apply for and receive services.

Examples of a suitable flyers are on the Substance Abuse and Mental Health Services Administration (SAMHSA) website at:

• 988 Suicide & Crisis Lifeline Poster (English)
• 988 Suicide & Crisis Lifeline Poster (Spanish)
• Suicide Warning Signs for Youth Poster
• Texting 988 Poster 1 (Spanish)
• Texting 988 Poster 2 (English)

Additional mental health and suicide prevention resources are available at:

• Behavioral Health Provider Resources
• Suicide Prevention
• 988 Partner Toolkit, SAMHSA
• Find Resources or a Provider, You're Not Alone, Mental Health Texas

Revision 24-2; Effective Sept. 20, 2024

Quality assurance and quality improvement (QA/QI) support the quality of clinical service delivery. Grantees must use internal QA/QI systems and processes to monitor services. Grantees must be able to meet the management standards per 2 Code of Federal Regulations Part 200.

QA/QI processes are intended to:

• improve screening and diagnostic services;
• link structure and process and include standards, measurement and actions;
• identify and remedy root causes of quality problems;
• meet client needs; and
• focus on high-volume, costly, high-risk or problem-prone aspects of care.

These aims are achieved by assessing performance, making changes based on the assessment and monitoring improvement. Steps to QA/QI include:

• Quality monitoring – The BCCS performance indicators are designed specifically for this purpose and represent aspects of care that align with the purpose of the NBCCEDP.
• Quality assessment – Assessing quality provides organizations with an opportunity to measure performance against standards, such as targets or benchmarks. Quality assessment creates a bridge between monitoring and improvement by establishing a common understanding of the quality of services provided and identifying opportunities for improvement.
• Quality improvement – QI strives to find strategies that will institute a change and continuously improve quality.

A Quality Management (QM) program must be developed and implemented that provides for ongoing evaluation of services. Grantees should have a comprehensive plan for the internal review, measurement and evaluation of services, the analysis of monitoring data, and the development of strategies for improvement and sustainability.

Grantees who subcontract to provide services must also address how quality will be evaluated and how compliance with HHSC policies and basic standards will be assessed with the subrecipients.

The QM Committee, whose membership consists of key leadership of the organization, includes the executive director, chief executive officer or both; the medical director; and other appropriate staff where applicable, annually reviews and approves the quality work plan for the organization.

2710 Quality Management (QM) Committee

Revision 23-2; Effective Sept. 29, 2023

The QM Committee must meet at least quarterly to:

• receive reports of monitoring activities;
• make decisions based on the analysis of data collected;
• determine quality improvement actions to be implemented; and
• reassess outcomes and goal achievement.

Meeting dates, minutes of the discussion and actions taken by the QM Committee and a list of the attendees must be maintained.

2720 Comprehensive Quality Work Plan

Revision 22-0; Effective August 15, 2022 

The comprehensive quality work plan, at a minimum, must:

• include clinical and administrative standards by which services will be monitored;
• include a process for credentialing and peer review of clinicians;
• identify those responsible for implementing, monitoring, evaluating and reporting;
• establish timelines for quality monitoring activities;
• identify tools and forms to be used; and
• outline reporting to the QM Committee.

2730 Quality Assurance Activities

Revision 25-3; Effective Sept. 1, 2025

Although each organization’s quality assurance program is unique, the following activities must be undertaken by all agencies providing client services:

• ongoing eligibility, billing and clinical record reviews to ensure compliance with program requirements and clinical standards of care;
• utilization review;
• tracking and reporting of adverse outcomes;
• client satisfaction surveys and reporting of survey data to HHSC in the frequency, manner and format defined by HHSC;
• annual review of facilities to maintain a safe environment, including an emergency safety plan;
• annual review and update of all prescriptive authority agreements (PAAs) for mid-level providers;
• annual review of all standing delegation orders and clinical protocols used;
• annual review of all policies and forms;
• up-to-date performance evaluations that include primary license verification, Drug Enforcement Administration, and immunization status; and
• clearly noted review or revision date on each policy, form, agreement or order used.

2740 Subrecipient Quality and Compliance

Revision 25-3; Effective Sept.1, 2025

Grantees who subcontract with subrecipients to provide services must also address how quality is evaluated and how compliance with policies and basic standards is assessed with the subrecipient. This includes at a minimum:

• annual license and certification verification which is the primary source verification;
• clinical record review;
• billing and eligibility review;
• utilization review;
• facility on-site review;
• annual client satisfaction evaluation process; and
• child abuse training and reporting.

Data from these activities must be presented to the QM Committee. Plans to improve quality should result from the data analysis and reports considered by the committee and should be documented.

2750 Clinical Quality Assurance

Revision 25-3; Effective Sept.1, 2025

Ambulatory Surgical Centers

Ambulatory surgical centers providing services must be Centers for Medicare and Medicaid Services (CMS) certified, state-licensed and Joint Commission-accredited, as applicable. Review the HHS Ambulatory Surgical Centers website for more information.

Mammography Quality Assurance

All grantees and subrecipients that provide mammography services must:

• possess a current Certification of Mammography Systems from each mammography unit who must be fully accredited or undergoing accreditation; and
• possess a current mammography facility certificate from the appropriate agency certifying compliance with the U.S. Food and Drug Administration Mammography Quality Standards, at 21 CFR Part 900.

The Mammography Radiation Control Program may be contacted for certification questions and information on inspection results, escalated enforcement or cease and desist status.

Cytology Quality Assurance

Grantees and subrecipients that provide screening and diagnostic cytology services must have current documentation that shows the agency meets all quality assurance standards required by the BCCS program under state and federal laws.

All cytology laboratories that provide services to grantees and subrecipients must:

• possess a current, unrevoked and unsuspended registration certificate issued by the U.S. Department of Health and Human Services per the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88) (42 U.S.C. Section 263a); and
• have a mechanism for expedited notification of Pap tests which are CIN III or greater, such that the clinic is notified by the next business day after the case is signed out.

Human Papillomavirus (HPV) Quality Assurance

Grantees must assure all HPV tests are:

• for high-risk oncogenic types; and
• FDA approved and clinically validated.

Utilization Review

To make sure clients receive high-quality care and funds are expended per program policies, BCCS performs utilization review of billed services. Grantees not in compliance with billing guidelines may be required to refund the BCCS program for services inappropriately billed.

2810 Fee-for-Service Reimbursement

Revision 25-3; Effective Sept.1, 2025

Client data must be entered in Med-IT® no later than 45 days after each service was provided. The fee-for-service component of funding pays for direct medical services on a fee-for-service basis. Each grantee is responsible for determining a person’s eligibility for clinical services. HHSC reimburses grantees on a fee-for-service basis for services that have been provided to eligible clients. Grantees must continue to provide services to established clients and submit claims for client services even after the grant funding limit has been met.

Grantees must file claims electronically through the Med-IT^® system. Those claims must be filed within the following time frames:

• Initial claims submission must be submitted within 45 days of the date of service on the claim. If the 45th day falls on a weekend or holiday, the filing deadline is extended until the next business day.
• All claims must be submitted and processed within 60 days after the end of the grant period.
• All claims must continue to be billed even after the grant funding limit has been met.

Grantees may contact Med-IT® Helpdesk for questions about claims and payment status.

HHSC reviews BCCS services and procedures grantee submits electronically to HHSC for processing.

Reimbursable Codes

Fee-for-service reimbursement is limited to a prescribed set of procedure codes approved by BCCS. The approved list of reimbursable codes is in Med-IT® and referenced in the BCCS Appendix VI, BCCS Billing Guideline. Grantees may email the BCCS Program to request more services be added to the program by requesting a Topic Nomination Form.  

Grantees may submit claims for a person’s office visits that reflect different levels of service for new and established people. A new person is defined as one who has not received clinical services at the grantee’s clinics during the previous three years. The level of services, which determines the procedure code to be billed for that client visit, is indicated by a combination of factors such as the complexity of the problem addressed, and the time spent with the client by clinic providers. The American Medical Association (AMA) publishes materials related to Current Procedural Terminology (CPT) coding that includes guidance on office visit codes (Evaluation and Management Services).

2820 Cost Reimbursement

Revision 25-3; Effective Sept.1, 2025

Cost Reimbursement provides funds to grantees that support the overall outcomes of clients served through BCCS Fee-for-Service. These funds must be used for support services that enhance BCCS Fee-for-Service client service delivery. Cost reimbursement awards must be used for client travel and may also be used for categories listed below per state and federal requirements.

Costs must be reasonable, allowable and already allocated, and may be assessed against any of the following optional categories the grantee identifies during its budget development process:

1. Administrative Personnel
2. Personnel Travel
3. Equipment
4. Supplies
5. Contractual
6. Other allowable direct costs not listed in any previous categories.

Grantees may request reimbursement for costs by submitting a monthly voucher packet for expenses outlined in a categorical budget approved by HHSC, as required for categorical cost reimbursement. Supporting documentation must be submitted with each voucher packet. HHSC will provide grantees with a personalized voucher packet and Financial Status Report (FSR) form at the beginning of each grant year. Grantees must submit the monthly voucher packet and the quarterly FSR to the designated email address on the forms.

• B-13X Form Budget Category monthly expenditures, program income and non-HHSC funding;
• Form 4116, Authorization for Expenditures;
• data management form Required Data Collection; and
• supporting documentation, such as a general ledger, must be submitted monthly with each voucher packet.

Categorical Budget Revisions

HHSC, at its sole discretion, may approve fund transfers between categories within the approved budget workbook upon a grantee’s written request. The request must include a detailed explanation that supports the need for the fund transfer. The grantee must seek HHSC’s written approval before making any fund transfers. Visit the Texas Grant Management Standards (TxGMS), Statewide Procurement Division, Version 2 for more information. Grantees must submit a revised budget to HHSC for review any time a budget revision is made.

Revision 25-3; Effective Sept. 1, 2025

Grantees must provide or assure the provision of breast and cervical cancer screening, diagnostic and support services, including tracking, follow-up, patient navigation and individual client education. Although BCCS allows the provision of diagnostic services, grantees must make sure program focus supports cancer screening consistent with funding intent.

Grantee requirements also include:

• program management;
• eligibility determination;
• initiation of or referral to treatment if clinically indicated;
• quality management;
• professional development;
• recruitment, including public education and outreach; and
• data collection, including tracking and follow-up.

Grantees:

• Are responsible for coordinating a client’s services from screening through diagnosis if clinically warranted.
• Who have expended their awarded funds must continue to serve their existing BCCS eligible clients currently in the process of an approved care plan.
• Must make sure existing clients receive services from qualified breast and cervical cancer providers to continue client care.

All grantees must have an established referral relationship and subcontract with a qualified provider of each service the grantee does not provide.

Note: Duplication of BCCS services by multiple grantees is not reimbursed. Before services may be rendered, grantees must have procedures to verify clients are not receiving services with another BCCS grantee. NBCCEDP funds cannot be used to cover services covered by another public health program or private coverage per 42 USC Section 300n(d).

Data Collection – Grantees must comply with and use the web-based system Med-IT® to collect and process breast and cervical cancer data. This includes reports and billing per the business requirements of the program.

Eligibility – Grantees must determine BCCS program eligibility of every client at enrollment and annually thereafter. Insurance status should be reassessed at each client visit.

Evidence-Based Interventions (EBIs) – Grantees must participate in HHSC-sponsored Evidence Based Intervention (EBI) project(s) based on performance and program goals, if identified by HHSC.

Partnerships – Grantees must establish and maintain partnerships with coalitions, community-based organizations and other health and human services agencies that further the goal of providing BCCS in the proposed service area.

Program Management – The process of leading, facilitating and making sure the strategic planning, implementation, coordination, integration and evaluation of programmatic activities and administrative systems to ensure efficiency and effectiveness.

Professional Development – Grantees are responsible for making sure health care professionals provide BCCS services competently.

Quality Management – Grantees are expected to ensure the quality of services by monitoring performance and identifying opportunities for improvement. They must have policies and procedures to make sure health care providers follow evidence-based clinical guidelines and provide clinical services consistent with current nationally recognized standards of care.

Recruitment – Grantees must establish and maintain outreach and in-reach methods to recruit priority populations.

Revision 24-2; Effective Sept. 20, 2024

3210 Eligibility Guidelines

Revision 25-3; Effective Sept.1, 2025

For an applicant to receive BCCS services, they must meet three general criteria. The person must:

• have a gross household income at or below 200% of the adopted Federal Poverty Level (FPL);
• be a Texas resident; and
• be without access to programs or benefits that provide the same services.

BCCS is the payor of last resort. Where a grantee is awarded multiple HHSC program grants, consult with the program policy manual for times where limited dual certification for which grantee billing is allowed. Grantee must seek HHSC approval for any times not clearly defined in the BCCS Program Policy Manual.   

Other Eligibility Factors

Other eligibility factors include:

• Applicant must meet age-specific eligibility criteria for screening and diagnostic services.
• Applicants with a primary need of cancer screening should be enrolled in BCCS.
• Applicants whose health insurance does not fully cover screening and diagnostic services are considered underinsured and may be enrolled for services. Note: Applicants eligible for Emergency Medicaid coverage through pregnancy and 12-month postpartum period, only receive treatment of emergency medical conditions. These applicants are considered underinsured and may be enrolled for BCCS services if they meet all other eligibility requirements. BCCS does not provide any emergency services.

Client Travel

Grantees must establish a policy for providing financial travel support to and from clinic or mobile location(s). Grantees must ensure that clients who receive travel assistance live within the HHSC-approved service delivery area. Criteria for client travel support must be income-based and include a justification of need. Grantee may include other factors.

Grantees may provide travel services through options such as bus passes, vouchers, and rideshare apps like Uber or Lyft.

Grantee Responsibilities for Eligibility Determination

Grantees must develop an agency policy to determine BCCS eligibility. The policy must outline the grantee’s procedures to determine program eligibility and who is responsible for eligibility screening. The policy must also be available during monitoring visits and must address:

• Acceptable documents to verify household income at or below 200% FPL. Income must be recorded in the client record and Med-IT^®.
• Use of Form 1065, Eligibility Application.
• Use of a comparable paper or electronic screening and eligibility tool with required information. Note: If a grantee wants to use an Alternate Eligibility Screening Tool (AEST), the grantee must send a request to BCCSProgram@hhs.texas.gov with AEST Request in the subject line. HHSC staff must review and approve before use. Grantees must use Form 1065 until they receive approval to use an AEST. The grantee must maintain and keep proof of approval and must make the approval available during QA visits.
• Applicants who served in any branch of the U.S. Armed Forces, Reserves or National Guard may be eligible for more benefits and services. Visit the Texas Veterans Portal for more information.

Grantee eligibility policy must also make sure:

• Client insurance status is assessed before service delivery.
• General BCCS eligibility is determined before enrollment and annually thereafter.
• Clients 65 and over do not meet eligibility unless the client is ineligible for or unable to pay premiums for Medicare Part B.

A woman who is eligible to receive Medicare benefits and is not enrolled in Medicare should be encouraged to enroll. Women enrolled in Medicare Part B are not eligible to receive services. Women who are not eligible to receive Medicare Part B and Medicare-eligible women who cannot pay the premium to enroll in Medicare Part B are eligible to receive services. If a client cannot afford Medicare Part B premiums, Medicaid-sponsored Medical Savings Programs may pay Medicare premiums, deductibles and coinsurance amounts for eligible Medicare beneficiaries. The Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualified Individuals (QI-1) and the Qualified Disabled Working Individuals (QDWI) program are all called Medicare Savings Programs. More information about Medicare Savings Programs is at Medicare Savings Programs | Medicare.

3220 Applying for Services

Revision 25-3; Effective Sept. 1, 2025

Screening and Eligibility Determination

Grantees must use Form 1065, Eligibility Application. An AEST with the required information to determine eligibility may be used if first approved by HHSC staff.

The applicant is responsible for completing Form 1065. If the applicant needs help completing the form, the grantee must provide knowledgeable staff to assist.

Client eligibility determination may be conducted by phone. Applicants may print the form, add a handwritten signature and scan, email or fax the form to a grantee. Client and grantee digital signatures are allowed. If needed, a grantee may sign on behalf of an applicant. If eligibility is determined over the phone, the grantee must read and get the applicant’s verbal authorization to sign or initial, where applicable, the application on the applicant’s behalf with a digital ID or handwritten signature. Anyone who helps the applicant complete the form must also sign and date the form.

Documenting Special Circumstances

There may be special circumstances where an applicant cannot provide required documentation for verification purposes. These types of special circumstances should be appropriately documented on Form 1065. Special circumstances must also be documented in the Med-IT® Data System in the notes section of the enrollment screen.

Residency

To be eligible for BCCS, a person must be physically present within the geographic boundaries of Texas. There is no requirement about the amount of time a person must live in Texas to establish residency for BCCS eligibility. The person must have the intent to remain within the state permanently or for an indefinite period.

Household

Establishing household size is an important step in the eligibility process. Assessment of income eligibility relies on an accurate count of household members. The household consists of a person who lives alone or a group of two or more people related by birth, marriage, including common law, or adoption, who live together and are legally responsible for the support of the other person. Unborn children should also be included. Treat applicants who are 18 years old as adults.

A BCCS-eligible applicant who is a legal adult must complete Form 1065.

The grantee has discretion to document special circumstances in the calculation of household composition.

Income

To be eligible for BCCS services, applicants must provide verification of countable household income at or below 200% of the Federal Poverty Level (FPL). If the applicant cannot provide verification, they may self-declare income. The reasons an applicant self-declares income must be documented in the client record and in the Med-IT® Data System. Both actual income amounts, which is income that was already received, and projected income amounts, which is income that has not been received but expected for the current month must be used to determine eligibility.

Note: Applicants who seek Medicaid for Breast and Cervical Cancer (MBCC) may not self-declare income. This includes women who have been diagnosed with a qualifying cancer by BCCS grantees or other health care providers. Applicants who received help from a BCCS grantee to apply for MBCC must have verification of income documented in their client record and on the eligibility screen in Med-IT®.

Income Deductions

Dependent care expenses and payments made by a member of the household group must be deducted up to the allowable amount as follows:

• legally obligated child support payments paid to the household;
• $200 per child per month for children under 2;
• $175 per child per month for children 2 – 17; and
• $175 per dependent adult with disabilities per month who is 18 and older.

Monthly Income Calculation

List the applicant’s household income in the table in Section IV of Form 1065. Include:

• income from work;
• income the applicant collects from charging room and board;
• the spouse’s income; and
• unemployment benefits.

Refer to the Texas Works Handbook for more countable and exempt income sources.

Calculate the Total Countable Monthly Income. Subtract the deductions to figure  the applicant’s total monthly adjusted gross household income if deductions are included.

When income is received in lump sums at irregular intervals or at longer intervals than monthly, such as contract labor, seasonal employment and lump sums, the total amount received is divided over the period for which the income is expected to cover household expenses to find a monthly income. Convert the amount with one of the following methods:

• Weekly income is multiplied by 4.33
• Income received every two weeks is multiplied by 2.17
• Income received twice a month is multiplied by 2.0
• Income received annually is divided by 12

Count the total income for the months worked in the overall calculation of income for seasonal income.

Calculation of Applicant’s FPL Percentage

1. Determine the applicant’s household size.
2. Determine the applicant’s total monthly income amount.
3. Divide the applicant’s total monthly income amount by the maximum monthly income amount at 100% FPL, for the appropriate household size.
4. Multiply by 100%.

The maximum monthly income amounts by household size are based on the U.S. Department of Health and Human Services federal poverty guidelines. The guidelines are subject to change near the beginning of each calendar year. However, grantees should not use updated federal guidelines until the BCCS program makes the necessary changes in Med-IT and a notification is sent to grantees on the updated guidelines’ effective date. The current FPL information is in Appendix V.

3230 Adjunctive Eligibility

Revision 25-3; Effective Sept.1, 2025

An applicant is considered adjunctively eligible, which is automatically eligible for BCCS services at an initial or renewal eligibility screening, if the applicant or a member of the applicant’s household is currently enrolled in one of the programs listed below. An applicant must provide proof of active enrollment in the adjunctively eligible program. Acceptable eligibility verification documentation may include the following.

3240 Date Eligibility Begins

Revision 24-2; Effective Sept. 20, 2024

Applicants are eligible to receive services the date an application is completed and the applicant is determined eligible. Services rendered before the date the applicant is determined eligible will not be reimbursed.

3250 Fees

Revision 23-2; Effective Sept. 29, 2023

Clients must not be charged administrative fees for items such as processing or transfer of medical records, or both, copies of immunization records and similar documents.

Grantees may bill clients for services outside the scope of BCCS allowable services if the service is provided at the client’s request and the client is made aware of their responsibility for paying the charges before services are rendered.

3260 Continuation of Services

Revision 23-2; Effective Sept. 29, 2023

Grantees who expend their awarded funds must continue to serve their existing eligible clients currently in the process of a care plan. It is allowable to obtain other funding to pay for these services. Dependent on the funding source, such funds may be counted toward the match requirement.

Grantees who expend their awarded funds are not required to enroll new clients. However, it is allowable to offer services at full pay or on a sliding scale basis.

3270 Med-IT® Data and Billing Services

Revision 25-3; Effective Sept.1, 2025

Med-IT^® users should verify a person is eligible for BCCS before adding a client to the database. Before entering a client’s information into the Med-IT^® database, grantees must do a client search to find out if she has:

• ever received services funded by BCCS; and
• an existing Med-IT^® identification number, which is a unique number assigned to each BCCS client.

This process can be completed by entering client identifiers, which may include name, date of birth, Social Security number or all three. A client’s address and ZIP code may also be used to search for an existing Med-IT^® identification number. If a client has an existing Med-IT^® identification number and received services in a different region, the grantee should submit a region change request to Med-IT@hhs.texas.gov.

Minimum PC Requirements for Med-IT^® are:

• Any internet connection – For optimum performance and response time, grantee locations should have access to a broadband connection with a minimum of 1 MB upload speed and 2 MB download speed.
• Google Chrome or Microsoft Edge.

Med-IT^® users must have access to the database and BCCS service providers must be listed in the database. New users may request access by completing Form 5200, Med-IT New User Request. New providers must complete Form 5201, Med-IT New Provider Request. Each of these forms must be submitted to Med-ITHelpdesk@hhs.texas.gov.

Revision 24-2; Effective Sept. 20, 2024

3310 BCCS Grantee Clinical Responsibilities

Revision 25-3; Effective Sept.1, 2025

Grantees must:

• administer pelvic examinations per Chapter 167A of the Health and Safety Code;
• accept referrals for Breast and Cervical Cancer Services (BCCS), funds permitting;
• assess all clients for their need of patient navigation services and provide such services accordingly;
• help eligible clients apply for Medicaid for Breast and Cervical Cancer (MBCC), including eligible clients diagnosed outside the BCCS program;
• make a good faith effort to get treatment for clients with a precancerous or cancerous breast or cervical diagnosis who do not meet the eligibility criteria for BCCS cervical dysplasia, MBCC or both;
• communicate with team members within your organization about program requirements of the BCCS program;
• provide and document monitoring and oversight of subrecipients and subcontracted services to ensure compliance with BCCS policies and standards;
• establish policies and procedures to ensure accurate information about BCCS and MBCC is provided when people call about services;
• train staff annually on these policies and procedures; and
• ensure callers are connected to staff responsible for scheduling appointments and answering program related questions in a timely manner.

3311 Covered Services

Revision 24-2; Effective Sept. 20, 2024

Breast and Cervical Cancer Services (BCCS) program services include:

• clinical breast examination;
• mammogram;
• pelvic examination and Pap test;
• diagnostic services;
• cervical dysplasia management and treatment; and
• help completing the Medicaid for Breast and Cervical Cancer (MBCC) application.

Detailed information on available BCCS services is in the BCCS Billing Guideline.

Telemedicine

Providers may provide services by telemedicine if appropriate. Providers who provide telemedicine services must follow all rules per the Texas Occupations Code 111.001 and must have written policies and procedures to do so that include:

• Informed consent;
• Confidentiality of the client’s clinical information;
• Ensure appropriate, quality care;
• Prevent abuse and fraud in the use of telemedicine services;
• Ensure adequate supervision of health professionals who are not physicians and who provide telemedicine care.
• Establish the maximum number of health professionals a physician may supervise through telemedicine services.

3320 Client Health Record and Documentation of Client Encounters

Revision 24-2; Effective Sept. 20, 2024

Client Health Records and Documentation

Grantees must make sure a client health record, a medical record, is established for every client who obtains BCCS services.

All client health records must be:

• complete, legible, written in ink or documented within an Electronic Medical Record (EMR). No erasures or deletions should occur in a health record.
• accurate documentation of all clinical encounters, including those by phone.
• signed by the provider who makes the entry, including the provider’s name, title and date for each entry.
  • Note: Electronic signatures are acceptable to document provider review of care. Stamped signatures are not acceptable.
• readily accessible to assure continuity of care and availability to patients.
• systematically organized to allow easy documentation and prompt retrieval of information.

All client health records must include:

• client identification, personal data and eligibility assessment, including an insurance assessment.
• preferred language, method of communication or both.
• client contact information with the best way to reach the client in a way that facilitates continuity of care, assures confidentiality and adheres to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.
• a problem list, updated as needed at each encounter, that indicates significant illnesses and medical conditions.
• a complete medication list that includes prescription and nonprescription medications and dietary supplements, updated at each encounter.
• a complete list of all medication allergies, adverse reactions and other allergic reactions displayed in a prominent place and confirmed or updated at each encounter. Properly note if the person has no known allergies.
• the person’s past medical history that includes all serious illnesses, hospitalizations, surgical procedures, pertinent biopsies, accidents, exposures to blood products and mental health history.
• a person’s health risk survey and assessment, which includes:
  • past and current tobacco, alcohol and substance use or misuse.
  • domestic or intimate partner violence, abuse or both. For any positive result, the person must be offered referral to a family violence shelter per Texas Family Code, Chapter 91.
  • occupational and environmental hazard exposure.
  • environmental safety, which can include seat belt use, car seat use and bicycle helmets.
  • nutritional and physical activity assessment.
  • living arrangements updated as appropriate at each encounter.
• at each encounter, an encounter-relevant history and physical examination pertinent to the person’s reason for presentation.
• assessment or clinical impression.
• a plan of care consistent with diagnoses and assessments, which are consistent with clinical findings, including:
  • education,
  • counseling,
  • treatment,
  • special instructions,
  • scheduled visits, and
  • referrals.
• appropriate laboratory and other diagnostic test orders, results and follow-up as indicated.
• recommended follow-up care, scheduled return visit dates and follow-up for missed appointments.
• informed consent or refusal of services, to include at a minimum:
  • general consent for care,
  • informed consent for any surgical or invasive procedures as indicated, and
  • for required or recommended services refused or declined by the person, documentation of the service offered, counseling provided and the person’s decision to decline.
• client counseling and education with attention to risks identified in the health risk assessment.

Note: The record must be updated at every clinic visit as appropriate. The reason for the visit, assessments made, if any, and the service provided must be documented.

A comprehensive client health record described above does not have to be established for clients referred only for Medicaid for Breast and Cervical Cancer (MBCC) assistance. The BCCS grantee must establish a Patient Navigation Record for these clients.

3321 Counseling and Education

Revision 23-2; Effective Sept. 29, 2023

For every woman who receives breast or cervical cancer screening, or both, or diagnostic services through BCCS, the service provider must effectively communicate and document the following information during the initial visit and update it during follow-up visits, as indicated by the client’s risk assessment:

• Risk factors for breast and cervical cancer
• Signs and symptoms of breast and cervical cancer
• The importance of cancer screening at regular intervals
• Limitations of screening, including limitations of imaging in women with dense breast tissue
• Information on human papilloma virus (HPV) and safe sex practices
• Information on the HPV vaccine
• An advisory that BCCS services and eligibility may change from year to year
• Information about tobacco cessation and a quit line referral, if appropriate

Tobacco Use Assessment and Texas Tobacco Quitline Referral

All women receiving BCCS services must be assessed for tobacco use consistently through standardized screening and referral procedures at every encounter. The assessment should be performed by agency staff and documented in the clinical record. Cessation rates improve when healthcare providers spend at least three minutes counseling their patients. Screening, counseling and referral to treatment do not need to be performed by the same healthcare provider.

Women who use any type of tobacco product, including electronic nicotine delivery systems, should be referred to the Texas Tobacco Quitline via one of the following:

• Paper-based fax referral;
  • Available on YesQuit.org
• Texas Quitline App referral;
  • Apple devices
  • Android devices
• Yes Quit Health Portal; or
• Tobacco protocol in electronic health records (EHRs).

The Texas Tobacco Quitline provides confidential, free and convenient cessation services to Texas residents ages 13 and older, including quit coaching and nicotine replacement therapy. Services can be accessed by phone at 1-877-YES-QUIT (1-877-937-7848) or online at YesQuit.org.

3330 Requirements for Policies to Ensure Appropriate Follow-up and Continuity of Care

Revision 23-2; Effective Sept. 29, 2023

Follow-up of Breast and Cervical Screening Results

The clinician must notify a woman of findings, reinforce the need for continued routine screening examination and provide the expected interval for her next routine screening examination. Grantees must attempt to remind each woman of her regular screening due date.

Rescreening Eligibility

Rescreening is the process of returning for a breast cancer screening or cervical cancer screening (or both) at a pre-determined interval (as per program guidelines) when no symptoms are present.

Women may return for rescreening if they continue to meet BCCS financial and clinical eligibility requirements. Women with a history of cancer may return for screening when they conclude their cancer treatment if they continue to meet BCCS financial and clinical eligibility requirements.

Exceptions to Rescreening

Grantees are not required to rescreen a client if the grantee has documented that she:

• cannot be located or has moved from the contractor’s service area;
• no longer meets the BCCS financial or clinical eligibility;
• has Medicare Part B or other adequate health insurance which provides coverage for breast and cervical cancer screening and diagnostic testing; or
• refuses, in writing or verbally, to return for services.

3331 Prescriptive Authority Agreements

Revision 25-3; Effective Sept. 1, 2025

The grantee is responsible for making sure a properly executed prescriptive authority agreement (PAA) is in place for each mid-level provider when an advanced practice registered nurse (APRN) or physician assistant (PA) provide services. The PAA must meet all requirements in Texas Occupations Code, Chapter 157, including the following criteria:

• be in writing and signed and dated by the parties to the agreement;
• be reviewed at least annually, including amendments;  
• be kept on-site where the APRN or PA provides care;  
• include the name, address and all professional license numbers of all parties to the agreement;
• state the nature of the practice, practice locations or practice settings;
• identify the types or categories of drugs or devices that may or may not be prescribed;
• provide a general plan to address consultation and referral;
• provide a plan to address client emergencies;
• describe the general process for communication and sharing information between the physician and the APRN or PA to whom the physician has delegated prescriptive authority about the care and treatment of clients;
• if alternate physician supervision is used, appoint one or more alternate physicians who may:
  • provide appropriate temporary supervision following the requirements established by the PAA and the requirements of this section; and
  • participate in the prescriptive authority quality assurance and improvement plan meetings required under this section;
• describe a prescriptive authority quality assurance and improvement plan and specify methods to document the implementation of the plan that includes:
  • chart review, with the number of charts to be reviewed determined by the physician and APRN or PA; and
  • periodic meetings between the APRN or PA and the physician at a location determined by the physician, APRN or physician assistant.

References

• Texas Occupations Code Title 3, Subtitle B, Chapter 157, Authority of Physicians to Delegate Certain Medical Acts
• Texas Administrative Code Title 22, Part 11, Chapter 222 APRN’s with Prescriptive Authority
• Texas Administrative Code Title 22, Part 9, Chapter 183 Physician Assistants
• Texas Nurse Practice Act Subchapter I, Section 301.4011, 301.402, 301.4025, 301.407 (PDF) Regarding Duty of Nurse to Report and Duty of State Agency to Report 

3340 Standing Delegation Orders

Revision 25-3; Effective Sept. 1, 2025

Standing Delegation Orders (SDOs) are written instructions, orders, rules, or procedures designed for a client population with specific diseases, disorders, health problems or sets of symptoms. This type of order provides a general set of conditions and circumstances when action can be instituted before being examined or evaluated by a physician. Clinics must have written SDOs in place as outlined in TAC Title 22, Part 9, Chapter 169, Subchapter A.

Standing delegation orders may permit the administering or providing of the following types of dangerous drugs if specifically ordered by or using a pre-signed prescription from the delegating physician:

1. oral contraceptives;
2. diaphragms and contraceptive creams and jellies;
3. topical anti-infectives for vaginal use;
4. oral anti-parasitic drugs for treatment of pinworms;
5. topical anti-parasitic drugs;
6. antibiotic drugs for treatment of venereal disease; or
7. immunizations

General standards for standing delegation orders, standing medical orders, and protocols require:

1. development and approval by the delegating physician or per facility bylaws and policies;
2. the order or protocol to be in writing and signed by the delegating physician;
3. a description of the specific instructions, orders, protocols or procedures to be followed,
4. a notation of the level of supervision required, unless specified by other law;
5. plans for addressing client emergencies;
6. annual review signed by the delegating physician; and
7. maintenance at the facility or practice site.

3341 Breast Clinical Policy

Revision 26-1; Effective Jan. 8, 2026

Breast Cancer Screening Eligibility

Applicants who meet general eligibility requirements and have breasts are eligible for breast cancer screening services. Breast screening refers to procedures that include clinical breast examination (CBE), screening mammogram and MRI for women who present without symptoms suspicious for breast cancer. For breast cancer screening to be most effective, the screening must be conducted at regular intervals.

Risk Screening and Client Counseling

All women should undergo a risk assessment to find out if they are at high risk for breast cancer. Women considered high risk include those who have:

• a known genetic mutation such as BRCA 1 or 2;
• first-degree relatives with premenopausal breast cancer or known genetic mutation;
• a history of radiation treatment to the chest area before they are 30 years old, typically for Hodgkin’s lymphoma;
• a lifetime risk of 20% or more for development of breast cancer based on risk assessment models largely dependent on family history; or
• Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.

Providers can choose the risk assessment method they prefer to find out if a woman is at high risk for breast cancer. Women at high risk should be screened with both an annual mammogram and an annual breast MRI.

All people should be counseled on breast cancer awareness and advised to be familiar with their breasts and to report promptly any changes such as a mass, lump, thickening or nipple discharge.

All people should be counseled on the benefits and risks of mammography. If a person has the option of a 3-D mammogram, they should be counseled on the benefits and risks of 3-D mammograms versus 2-D mammograms to make an informed decision.

Screening Frequency

The following women may receive breast cancer screening services every one to two years based on the woman’s history and clinical presentation:

• women 40 and older, and
• high-risk women younger than 40.

Note: Grantees must use the Health History Screen in Med-IT^®  to document high-risk assessment.

3342 Components of Breast Cancer Screening

Revision 25-3; Effective Sept. 1, 2025

The grantee must provide a complete breast cancer screening, which includes a mammogram, individualized client education, tobacco use assessment and Quit Line referral, if indicated. A screening may include a clinical breast examination (CBE). The grantee must document the breast cancer screening components in the client’s record and Med-IT^®.

A breast health history must be included as part of the breast cancer screening. The health history includes:

• date and time intervals of previous mammograms;
• results of previous mammograms;
• date and results of the last CBE;
• date and results of any previous breast surgery;
• date of last menstrual period;
• medication history, including current or previous use of hormones such as hormone replacement therapy and oral contraceptives;
• other risk factors for breast cancer such as personal history of breast cancer or family history of first-degree relatives with breast cancer; and
• description of breast symptoms, if any.

Clinical Breast Examination

A CBE is not a prerequisite for reimbursement for a screening mammogram by the BCCS program. Grantees should document if a CBE is not indicated for Minimum Data Element (MDE) records. CBEs must be performed by a physician, physician assistant, nurse practitioner, certified nurse midwife or additionally a qualified registered nurse with specialized training as required under standing delegation orders (SDOs). The specialized RN CBE training must be documented in the personnel record including an educational certificate, a degree, or continuing education credits. Complete documentation of the CBE must be included in the client health record and Med-IT^®.

Screening Mammogram Special Circumstances

Additional views, as used with a diagnostic mammogram such as four to six specified diagnostic views, can be used to screen women with the following special circumstances:

• Cosmetic or reconstructive breast implants
• A history of breast cancer and lumpectomy (partial mastectomy)

Screening Magnetic Resonance Imaging (MRI)

Breast MRI may be reimbursed by BCCS along with a screening mammogram after program approval. Grantees must request approval using Form 5203, Breast MRI Pre-Authorization Request. Once reviewed by HHSC clinical staff, Form 5203 is returned to the grantee within 10 business days.

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 history of breast cancer after completing treatment.

MRI Restrictions:

• Breast MRI must never be performed alone as a breast cancer screening tool.
• Breast MRI cannot be reimbursed to assess the extent of disease for staging in women already diagnosed with breast cancer.
• All breast MRI procedures require pre-authorization.
• MRI procedures must be performed in facilities with dedicated breast MRI equipment able to perform MRI-guided breast biopsies.

Imaging Reports – Screening Mammogram and MRI

Radiology facilities must prepare a written report of the results of each radiologic examination, including screening mammography and MRI. This report must include the following:

• name of the client and an additional client identifier;
• name of the physician who interpreted the mammogram; and
• an overall final assessment of findings using the Breast Imaging Reporting and Data System (BIRADS) classification.

Funding for Screening Mammograms and MRI

Reimbursement for screening mammograms and MRI for high-risk asymptomatic women 40 – 49 must initially be billed using the B codes listed in the BCCS Billing Guideline.

Note: BCCS funds may not be used for breast cancer screening in clients under 40.

3343 Breast Cancer Diagnostic Services

Revision 25-1; Effective Feb. 4, 2025

Breast Cancer Diagnostic Eligibility

Applicants 18 to 64 may be eligible for breast cancer diagnostic services if they have an abnormal breast cancer screening result and meet program eligibility requirements.

Managing Women with Abnormal Breast Cancer Screening Results

The management of women whose mammogram, clinical breast examination (CBE), or both, are abnormal relies on a body of scientific literature that is constantly growing and changing. Providers should follow standards such as the Breast Cancer Screening and Diagnosis - Guidelines Detail and the Clinical Resources.

Reimbursement for Complications of Breast Procedures

Grantees may request reimbursement for treatment costs associated with client complications related to breast biopsy procedures that occur in the immediate post-procedure or post-operative period, excluding inpatient hospital services. Grantees may be reimbursed through a voucher system for approved charges up to $3,000 per occurrence from awarded contract funds. To request reimbursement, grantees must email the Breast and Cervical Diagnostic Procedure Complication Reimbursement Request Form 5205 and supporting documents to BCCS program staff at BCCSprogram@hhs.texas.gov.

Supporting documents include the following:

• The client’s Med-IT® ID and date of service when treatment procedures were performed on the client in question.
• A narrative summary detailing the breast biopsy procedure performed and any related complications which have been documented in the Navigation or Cycle Note section of the client’s Med-IT® record.
• All emergency room, surgical and office progress notes, and similar notes related to complications of the procedure.
• The procedure notes, operative report or both, and similar documentation for the initial procedure.
• A completed paper Health Insurance Claim Form (CMS-1500) detailing the procedures for which the grantee is seeking reimbursement.

List all procedures related to the complication even if they are not typically reimbursable under the BCCS Program.

3350 Cervical Clinical Policy

Revision 24-2; Effective Sept. 20, 2024

3351 Cervical Cancer Screening Services

Revision 26-1; Effective Jan. 8, 2026

Applicants who have a cervix and present without symptoms suspicious for cervical cancer are eligible for cervical cancer screening services. Cervical screening refers to procedures that include pelvic exam, Pap test and Human Papilloma Virus (HPV) testing. For cervical cancer screening to be most effective, the screening must be conducted at regular intervals. Outreach efforts should be focused on persons who have never been screened or not been screened for cervical cancer within the past 10 years.

Cervical Cancer Screening Management

Cervical cancer screening is primarily performed with the Pap test and the HPV DNA test. BCCS uses U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations.

Clinical and reimbursement guidelines for cervical screening are:

• 21 – 29: Screen for cervical cancer every three years with cytology alone.
• 30 – 64: Screen for cervical cancer every three years with cytology alone, or every five years with hrHPV testing alone, or every five years with cotesting.
• Younger than 21: Not eligible for cervical cancer screening.

Special circumstances may warrant alterations in screening intervals as determined by a clinician. Special circumstances must be documented in the Med-IT® Minimum Data Elements (MDE) Summary of Notes section. This section is under the BCC Data section (BCC – MDE Notes). Special circumstances may include:

• Clients considered high-risk, for example, HIV positive, immunosuppressed, exposed to diethylstilbestrol (DES) in utero or history of cervical cancer.
• Clients who had a hysterectomy for cervical intraepithelial neoplasia (CIN) disease. These clients may continue screening for 20 years.
• Clients who have had cervical cancer. These clients may be screened indefinitely if they are in good health.
• Clients who have had a hysterectomy for benign disease and the cervix is still present. These people may be eligible for cervical cancer screening services. Funds can be used to pay for an initial exam to determine if the cervix is still present.

3352 Cervical Cancer Diagnostics

Revision 25-1; Effective Sept. 1, 2025

Cervical Cancer Diagnostic Eligibility

Applicants 18-64 years old who meet BCCS general requirements may receive diagnostic services. BCCS funded diagnostics services must be delivered per the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines.

Follow-up for Abnormal Cervical Screening

When the results are abnormal more diagnostic follow-up is required. A normal Pap test does not rule out cancer if a woman has a cervical lesion on pelvic examination. A colposcopy, cervical biopsy or both are allowed if determined appropriate by the clinician after an abnormal pelvic exam.

BCCS grantees must follow the algorithms for the management of the specific type of abnormal result and in consideration of special populations such as pregnant women and clients 20 years and younger or at high-risk. Refer to 3341, Breast Clinical Policy, for more information about risk screening and client counseling.

Diagnostic Procedures

Tests performed to confirm or rule out cancer when screening tests yield abnormal results include colposcopy, cervical biopsy, endocervical curettage (ECC) and diagnostic excisional procedures. A clinical breast exam (CBE) is not required when a client is referred to BCCS after an abnormal pelvic exam or abnormal Pap test. Diagnostic procedures must be performed by qualified clinicians with specialized training such as physicians, physician's assistants, nurse practitioners or certified nurse midwives.

Clinical Utilization Restrictions for Diagnostic Procedures

Diagnostic loop electrosurgical excision procedure (LEEP), conization, laser conization and cold knife conization cannot be performed on the following clients:

• Any age in the absence of high-grade squamous intraepithelial lesion (HSIL), ASC-H or higher abnormality.
• Any age with histology cervical intraepithelial neoplasia (CIN) I or lesser abnormality for a duration of less than two years and in the absence of HSIL or atypical glandular cells (AGC) on Pap tests.

Other Restrictions

The BCCS program monitors the use of facility and anesthesia services for cold knife conization and for use with LEEP.

Grantees are encouraged to develop subcontracts with practitioners who have specialized training in the management of cervical disease, including LEEP, as an office-based procedure.

Consultations

Consultations for follow-up of abnormal cervical results must be performed by health care providers with specialized training in the management of cervical disease, including skill performing invasive diagnostic procedures.  

A consultation may be performed only by a health care provider who did not perform the original screening examination. If that health care provider is not a licensed physician, appropriate protocols must be established and documented for that provider. Consultations must involve direct examination of the client and be billed using office visit codes.

Access to Treatment

The following treatment options may be available for eligible clients with a qualifying diagnosis:

• Cervical dysplasia management and treatment of clients who have a qualifying diagnosis and are not eligible for Medicaid for Breast and Cervical Cancer (MBCC). For a description of qualifying diagnoses, see 3353, Cervical Dysplasia Management and Treatment.
• MBCC for applicants who have qualifying breast or cervical cancer diagnoses and meet all other MBCC eligibility criteria. Refer to 3354, Medicaid for Breast and Cervical Cancer, and the MBCC Guidelines for Determination of Qualifying Diagnosis for guidance.

Office-based Procedures Performed in an Ambulatory Surgical Center

Special circumstances may arise that necessitate an office-based diagnostic procedure being performed in an ambulatory surgical center. These services require pre-authorization before the client receives services in an ambulatory surgical center or other outpatient facility. Grantees must submit the Office-based Procedures Performed in an Ambulatory Surgical Center Pre-authorization Form 5204, along with all supporting documentation to the BCCS Program staff. Once reviewed by BCCS clinical staff, Form 5204 is returned to the grantee within 10 business days. BCCS will not reimburse for any office-based procedures performed in an ambulatory surgical center are not pre-authorized. Evidence of pre-authorization approval must be made available to BCCS review staff during monitoring on-site visits.

Note: Special circumstances may include clients with a history of cervical cancer, obesity, cervical stenosis, vaginal stenosis or atrophy.

Reimbursement Following Complications of LEEP and LEEP Conization Procedures

Grantees may request reimbursement for treatment costs associated with client complications related to LEEP and conization procedures that occur in the immediate post-procedure or post-operative period, excluding inpatient hospital services. Grantees may be reimbursed through a voucher system for approved charges up to $3,000 per occurrence from awarded contract funds. To request reimbursement, grantees must email the Breast and Cervical Diagnostic Procedure Complication Reimbursement Request Form 5205 and email supporting documents to BCCS program staff.

Supporting documents include:

• The client’s Med-IT^® ID number and date of service when the treatment procedure was performed on the client in question.
• A narrative summary that details the LEEP or conization procedure performed and related complications which have been documented in the Case Management or Cycle Note section of the client’s Med-IT^® record.
• All emergency room, surgical and office progress notes for the client related to complications of the procedure.
• The procedure notes and operative report, or both for the initial procedure.
• A completed Health Insurance Claim Form, CMS-1500, that details the procedures that the grantee seeks reimbursement. List all procedures about the complication even if they are not typically reimbursable under the BCCS program.

3353 Cervical Dysplasia Management and Treatment

Revision 25-3 Effective Feb. 4, 2025

Grantees may receive limited state funding for management and treatment of cervical dysplasia (CD). CD procedures are reimbursed from non-federal funding, as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) prohibits use of The Centers for Disease Control and Prevention (CDC) grant funds for treatment.

Cervical Dysplasia Eligibility

Applicants must meet BCCS general eligibility criteria and have a definitive, biopsy-confirmed diagnosis of one of the following:

• CIN I, CIN II, CIN II-III; or
• high-grade dysplasia, which is severe dysplasia, or CIN III or CIS.

Grantees must assess clients with severe dysplasia, CIN III or CIS for MBCC eligibility before using non-federal funding to pay for treatment services.

Components of Cervical Dysplasia Services

Cervical dysplasia management and treatment may include the following services:

• Follow-up testing and observation without treatment, for example, cytology Pap tests, HPV testing and colposcopy.  
• Treatment using excision or ablation, for example, cryotherapy and cervical conization.
• Patient Navigation, refer to 3360, Patient Navigation Services.

Reimbursement for Cervical Dysplasia Management and Treatment Services

Reimbursement for cervical dysplasia services is limited to the codes which begin with CD, FCX and FCD listed separately in the BCCS Billing Guideline. These codes must be billed in the Med-IT^® system. Grantees should bill CD services throughout the dysplasia plan of care and return clients to BCCS services once released to routine screening intervals by the provider.

BCCS grantees must submit specimens for program covered laboratory testing to a U.S. Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory and adhere to all quality management requirements for cytology quality assurance.

Office-based Procedures Performed in an Ambulatory Surgical Center

Special circumstances may arise that necessitate an office-based diagnostic procedure being performed in an ambulatory surgical center. These services require pre-authorization before the client receives services in an ambulatory surgical center or other outpatient facility. Grantees must submit the Office-based Procedures Performed in an Ambulatory Surgical Center Pre-Authorization Form 5204, along with all supporting documentation to BCCS Program staff. Once reviewed by BCCS clinical staff, Form 5204 is returned to the grantee within 10 business days. BCCS will not reimburse for any office-based procedures performed in an ambulatory surgical center that are not pre-authorized. Evidence of pre-authorization approval must be made available to BCCS review staff during monitoring on-site visits.

Note: A special circumstance may be an abnormal pelvic exam, a client with a history of cervical cancer, obesity, cervical stenosis, vaginal stenosis or atrophy.

3354 Medicaid for Breast and Cervical Cancer

Revision 25-3; Effective Sept.1, 2025

The Texas Health and Human Services Commission (HHSC) administers the Medicaid for Breast and Cervical Cancer (MBCC) Program. MBCC is a special Medicaid program authorized by federal and state laws to provide access to cancer treatment services through full STAR+PLUS Medicaid benefits to qualified women. Refer to 42 Code of Federal Regulations Section 435.213, Human Resources Code Section 32.024(y) and (y-1) and TAC Title 1, Part 15, Chapter 366, Subchapter D.

Grantees must help women across the state, who are diagnosed with breast or cervical cancer by a BCCS grantee, who self-refer, or are referred by a non-BCCS provider, with completion and submission of the MBCC application. Grantees must determine presumptive eligibility for qualified women, and assess patient navigation per protocols specified in 3360, Patient Navigation Services. Grantees must offer in-person and remote options to help women complete and submit MBCC applications.

MBCC Eligibility

Applicants must meet each of the following criteria:

• have a biopsy-confirmed qualifying breast or cervical cancer diagnosis;
• need treatment for  breast or cervical cancer;
• be at or below 200% of the federal poverty level;
• be uninsured meaning, she must not otherwise have creditable coverage;
• be under 65 years old;
• provide their Social Security number or proof they have applied for one;
• be a U.S. citizen or eligible immigrant; and
• be a Texas resident.

Refer to MBCC eligibility guidelines and verification requirements in Part X- Medicaid for Breast and Cervical Cancer of the Texas Works Handbook.

Presumptive Eligibility

Presumptive eligibility is a Medicaid option that allows states to enroll women in Medicaid for a limited period before a full citizenship or legal immigrant eligibility determination is complete. Presumptive eligibility facilitates the prompt enrollment and immediate access to services for women who need treatment for breast or cervical cancer. The earliest date presumptive eligibility may begin is the day after the client received a biopsy-confirmed qualifying diagnosis.

Coverage

The earliest date a woman may be enrolled in full Medicaid coverage through MBCC is the day after a biopsy-confirmed qualifying diagnosis. Coverage may continue through the duration of her cancer treatment. MBCC services include the full range of Medicaid benefits and the treatment of breast or cervical cancer. If a client has a question about her Medicaid benefits or wants to locate a Medicaid provider in their area, she can call the TMHP Medicaid Client Help Line at 800-335-8957.

A client can continue to receive MBCC benefits if she meets the eligibility criteria and provides proof from her treating physician that she is receiving active treatment for breast or cervical cancer. The client must return Form H1551, Treatment Verification, and Form H2340, Medicaid for Breast and Cervical Cancer Renewal, to HHSC Centralized Benefit Services (CBS) before the end of the 12-month coverage renewal period.

If the client’s cancer is in remission and the physician determines the client requires only routine health screenings such as annual breast examinations, mammograms or Pap tests as recommended by the American Cancer Society and the U.S. Preventative Services Task Force, the client is not considered to be receiving treatment and MBCC coverage would not be renewed. If a client is later diagnosed with a new breast or cervical cancer, recurrence of breast or cervical cancer, or metastasis related to the primary qualifying diagnosis, she may reapply for MBCC.

BCCS Grantee Responsibilities

BCCS grantees are responsible for determining presumptive eligibility for qualified women and assessing patient navigation needs.

Initial BCCS grantee and subrecipient responsibilities include:

• collection and review of documents for eligible income, age, insurance, citizenship, and biopsy-confirmed qualifying diagnosis.
• help completing Forms 1065 and H1034;
• completion of Med-IT^® data entry and billing before submitting the completed MBCC application to BCCS, which includes the Final Diagnosis and Treatment screen in Med-IT for clients diagnosed with BCCS funds.

BCCS grantees must submit the MBCC application and other required documents no later than two working days from the date presumptive eligibility determination is made. For MBCC application instructions, refer to Appendix I, Medicaid for Breast and Cervical Cancer (MBCC) Application Checklist. For determining a qualifying diagnosis, refer to Appendix II, Medicaid for Breast and Cervical Cancer (MBCC) Guidelines.

BCCS State Office Responsibilities

BCCS program staff are responsible for reviewing the client’s application, required clinical documents and other required documentation. Staff submit the information to HHSC Centralized Benefit Services (CBS) within five business days of receipt of the complete application package.

Note: Once submitted for consideration to HHSC CBS, BCCS staff cannot review the application status. Staff do not help with or collect documents for pended MBCC applications.

HHSC MBCC Eligibility Staff Responsibilities

HHSC CBS staff verify receipt of the Form H1034 application within 48 hours and process the application within two business days of receipt. If more information is required, clients are placed on MBCC presumptive status and allowed 10 days to provide the required information. Eligibility for all applications is determined within 45 calendar days of receipt of the application packet.

Eligibility Determination Group (EDG) disposition is the result of processing the request for assistance and making an eligibility determination. The Texas Integrated Eligibility Redesign System (TIERS) generates Form TF0001, Notice of Case Action when the EDG is disposed. Form TF0001 is sent the same day eligibility is determined. This notice informs clients of their Medicaid status with an effective date of coverage and notifies the client of their EDG number. Clients may contact 2-1-1 to request the status of their application and Medicaid number.

MBCC inquiries from BCCS grantees on client reinstatements, approvals, denials and final application status should be emailed to Centralized Benefit Services-Medicaid for Breast & Cervical Cancer (CBS MBCC).

Medicaid Reinstatement

A client enrolled in Medicaid under MBCC within the past 12 months, and who is no longer on Medicaid but is still in active treatment or in need of active treatment for the original cancer, may have her MBCC reinstated. Reinstatements are handled directly by HHSC CBS. The BCCS grantee may help the client by:

• requesting Form H1551 and Form H2340 by calling 2-1-1 or 877-541-7905;
• helping complete the required documents; and
• faxing Forms H1551 and H2340 to HHSC CBS.

State-to-State Transfers

State-to-state transfers are handled by HHSC CBS. Form H1034 should not be submitted.

Clients must request an out of state MBCC application,  Form H2340-OS, Medicaid for Breast and Cervical Cancer and Form H1550, Out of State NBCCEDP Verification. These forms may be requested by calling 2-1-1 or 877-541-7905.

3360 Patient Navigation Services

Revision 25-3; Effective Sept. 1, 2025

Patient navigation is defined as individualized assistance provided to women to help overcome barriers and facilitate timely access to quality screening and diagnostic services and initiate timely treatment for those diagnosed with cancer.

Patient Navigation Activities

Although patient navigation services vary based on a client’s needs, at a minimum, patient navigation for women served by the BCCS program must include the following:

• an assessment of the client’s barriers to cancer screening, diagnostic services and initiation of cancer treatment;
• client education and support;
• resolution of client barriers such as transportation and translation services;
• client tracking and follow-up to monitor progress in completing screening, diagnostic testing and initiating cancer treatment;
• a minimum of two, but preferably more, contacts with the client;
• collection of data to evaluate the primary outcomes of patient navigation, such as client adherence to cancer screening, diagnostic testing and treatment initiation; and
• tracking of clients lost to follow-up.

Assessment is a cooperative effort between the client and patient navigator to examine and document the client’s needs, such as diagnostic, treatment, and essential support services through a process of gathering critical information from the client.

Planning uses short- and long-term needs identified in the assessment to establish planned services, time frames, and follow-up. As applicable, time frames must be consistent with BCCS required screening and diagnostic intervals. Services must be completed no later than 30 days from the date of the planned activity or before initiation of treatment, whichever is sooner.

Coordination is the implementation of the service plan, which includes the appropriate use of available resources to meet the client’s needs. Coordination of services may include scheduling appointments, making referrals, and obtaining and disseminating appropriate reports.

Monitoring is the ongoing assessment of the client’s service plan to make sure the client’s needs are met. In addition to monitoring clients who are receiving patient navigation services, grantees must establish a system to monitor abnormal screening or diagnostic results that identifies clients who need to have patient navigation initiated.

Resource Development

Patient navigators are responsible for identifying resources to meet client needs, including dysplasia and cancer treatment services, regardless of client ability to pay. Documentation must be maintained in a resource directory developed specifically to detail services that support BCCS-enrolled women with unmet needs.

Grantee Requirements

All women enrolled in BCCS must be assessed for their need of patient navigation services and provided with such services accordingly. Grantees are required to provide patient navigation services to:

• BCCS-enrolled clients with abnormal screening or diagnostic results;
• clients referred to BCCS with qualifying breast or cervical cancer diagnoses that are presumptively eligible for Medicaid for Breast and Cervical Cancer (MBCC); and
• clients referred to BCCS for cervical dysplasia management and treatment. Cervical dysplasia recipients must not be eligible for MBCC.

Patient navigation does not include eligibility determination or navigation of MBCC applicants whose presumptive eligibility determination was inaccurate.

Terminating Patient Navigation

Depending on screening and diagnostic outcomes, patient navigation services are terminated when a client:

• completes screening and has a normal result;
• completes diagnostic testing and has normal results;
• has attended a referral appointment for treatment;
• is documented as lost to follow-up or refused services;
• has had a good faith effort made per BCCS policy; or
• initiates or refuses cancer treatment.

When a client concludes her cancer treatment and has been released by her treating physician to return to a routine screening schedule, she may return to the program and receive all services, including patient navigation, if she continues to meet BCCS eligibility requirements.

Requirements for Patient Navigation Compliance

Navigation of patients must meet the following requirements:

• Patient navigation must include an assessment for needs and care coordination planning.
• The assessment is to be conducted within 30 days from the date of referral for diagnostic procedures, or before the initiation of the first diagnostic service, whichever is sooner.
• The assessment should be conducted in person, by phone, or with virtual telehealth software in a face-to-face interview format if possible.
• The service plan must be documented in the Med-IT^® Data System Navigation screen and the client’s office progress notes.
• The grantee must make sure monitoring of abnormal results is conducted and documented at the grantee level.
• The grantee must contact clients with abnormal screening and noncancerous diagnostic results no later than 30 days following receipt of an abnormal result. All screening and diagnostic services must be documented, including procedure-specific consent if applicable.
• The grantee must contact clients with cancer diagnoses no later than two weeks following the receipt of a cancer diagnostic result. All screening and diagnostic services must be documented, including procedure-specific consent, if applicable.
• Within one month after completion of the patient navigation plan for a diagnosis of cancer or cervical dysplasia, the patient navigator must follow-up and document that the service was implemented.
• As more needs are identified, they are recorded on the plan and the accompanying services and time frames are indicated.
• Grantees must develop and maintain a resource directory that contains information on services that could support women with unmet needs who are eligible for BCCS.
• Grantees must document client refusal, loss to follow-up, and good faith effort as appropriate.

Navigation of MBCC Referrals

Referred MBCC applicants must be provided a needs assessment and MBCC application assistance if determined to meet presumptive eligibility. BCCS grantees may choose to provide patient navigation for MBCC referrals that were determined to be ineligible. If patient navigation is initiated for a client found to be ineligible for MBCC, BCCS grantees must follow the client until treatment is initiated but may not bill BCCS for the patient navigation services provided. If patient navigation will not be initiated, the client should be provided with information about available local resources and referred to the diagnosing health professional.

Good Faith Effort

A good faith effort is defined as at least three documented attempts to get treatment or to navigate clients with a precancerous or cancerous breast or cervical diagnoses who do not meet the eligibility criteria for cervical dysplasia or MBCC enrollment. Examples include seeking service(s) for clients through the American Cancer Society, Susan G. Komen for the Cure, Livestrong, other health care providers and facilities through pro bono, sliding fee scale, reduced payment plan or sponsorship assistance.

3361 Client Refusal of Services

Revision 23-2; Effective Sept. 29, 2023

The grantee must attempt to obtain, in writing, and document in the client record informed refusal from the client if the client fails to keep appointments or refuses recommended procedures. If the client cannot, or will not, sign an informed refusal, the grantee must document verbal refusal. Before closing the client record as a refusal, a thorough review of the client’s plan, recommendations and navigator's actions must be conducted to ensure proper closure.

Lost to Follow-up

Before a grantee can consider a client as lost to follow-up, the grantee must have at least three documented attempts to contact the client, with the last attempt sent by certified mail. The grantee must allow enough time between contact attempts for the client to reply or respond to the grantee.

Client contact attempts can be made by:

• office visit;
• phone;
• home visit;
• mail; or
• a combination of these methods.

Attempts to contact the client must be written or presented verbally (when appropriate) in the client’s primary language (if the client has limited English proficiency) and must include appropriate provisions for the visually and hearing impaired.

Revision 25-3; Effective Sept. 1, 2025

Grantees must submit the following reports accurately and timely throughout the grant term, regardless of status, to report on progress and implementation.

3410 Financial Status Report (FSR)

Revision 26-1; Effective Jan. 8, 2026

The FSR includes all expenditures, program income and non-HHSC funding for the defining three months in each quarter with amounts received from HHSC. The FSR is due within 30 calendar days after the end of each quarter. Final FSR is due 45 calendar days after the end of the grant term.

3420 Monthly Voucher Packet

Revision 26-1; Effective Jan. 8, 2026

The monthly voucher packet is submitted to request reimbursement for the cost reimbursement portion of the grant. The monthly voucher packet and supporting documentation is due the last business day of the month following the month where expenses were incurred or services provided. Final voucher is due 45 days after the end of the grant term.

3430 Match Report

Revision 26-1; Effective Jan. 8, 2026

Matching funds refer to non-federal resources such as money and in-kind contributions. The Centers for Disease Control and Prevention (CDC) requires the BCCS program to provide $1 in match for every $3 of CDC funding awarded. Grantees must secure, budget, expend and report the non-federal match. Grantees submit match reports and the completed form by email to HHSC FCS Finance 30 days after the end of each quarter.

3440 Clinical Performance Measures

Revision 26-1; Effective Jan. 8, 2026

Performance Indicators and Reports

Grantees are required to meet National Breast and Cervical Cancer Early Detection Program (NBCCEDP) performance measures. The following performance indicators (PIs) are used to assess, in part, the grantee’s effectiveness providing BCCS services. Screening indicators are as follows:

1. A minimum of 35% of all NBCCEDP-reimbursed cervical cancer screenings should be provided to program-eligible women 30 and older who have never been screened or not screened within the last 10 years through the program. Grantees may use conventional or liquid-based cytology.

Cervical cancer diagnostic indicators are:

2. A minimum of 90% of cervical screening records with planned and complete diagnostic follow-up.
3. The interval between screening and final diagnosis of cervical cancer screenings should be 60 days or less for a minimum of 75% of the women.
4. A minimum of 90% of cervical cancer records with final diagnosis of HSIL, CIN2, CIN 3, CIS or invasive cervical cancer must have started treatment.
5. The interval between final diagnosis and initiation of treatment for HSIL, CIN2, CIN3, CIS or invasive cervical cancer should be 60 days or less for a minimum of 80% of the women.

Breast cancer diagnostic indicators are:

6. A minimum of 90% of mammogram screening records with abnormal results must have a completed diagnostic follow-up.
7. The interval between completed follow-up and time between abnormal screening and final diagnosis should be 60 days or less for a minimum of 75% of women.
8. A minimum of 90% of breast cancer records with a final diagnosis of CIS, other, or DCIS, or invasive breast cancer must have started treatment.
9. The interval between final diagnosis and initiation of treatment for breast cancer records with a final diagnosis of CIS, other, or DCIS, or invasive breast cancer should be 60 days or less for a minimum of 80% of women.

Note: These performance measures are subject to change. Performance Indicator Report (PIR) is due no later than the 10^th day of the end of the quarter to Med-ITHelpDesk@hhs.texas.gov.

Follow-up Report (FUR)

FUR summarizes all pending follow-up examinations, diagnosis, and treatment initiation for the specified time frame. The FUR is due by email no later than the 10^th day of the end of the month to HHSC Med_IT Helpdesk.

Minimum Data Elements (MDE)

MDE are a set of standardized data elements used to collect demographic and clinical information on women screened with BCCS funds. MDEs are due no later than the 10^th calendar day of the end of the month to HHSC Med_IT Helpdesk.  Grantees must submit the questionnaire linked in the MDE Calendar and Instructions to HHSC by the due date. Once HHSC receives the completed questionnaire, the deliverable is met.

3510 Promotion and Outreach Activities

Revision 25-3; Effective Sept. 1, 2025

Grantees must engage in promotion and outreach activities in each of the counties designated as a service area during the grant term.

The purpose of program promotion, outreach and in-reach is to:

• inform the public of the purpose of the program and available services;
• enhance community understanding of program objectives;
• disseminate breast and cervical cancer screening knowledge;
• enlist community support; and
• enroll clients for BCCS.

BCCS grantees must develop an annual promotion and outreach plan within 45 days of the start of each fiscal year. Grantees should follow the plan and make the plan available for monitoring purposes.

The plan should be based on an assessment of the needs of the geographic community and contain an evaluation strategy. Grantees should consider a variety of program promotion and client outreach strategies per organizational capacity, availability of existing resources and materials, and the needs of the local community.

3520 Promotion and Outreach Survey

Revision 25-3; Effective Sept. 1, 2025

To gauge the effectiveness of program promotion and client outreach activities, BCCS grantees must complete an HHSC-distributed survey twice annually to report on promotion and outreach efforts. Surveys must be completed within 30 days of receipt and are emailed to grantees by the HHSC BCCS Program. Email questions about the plan and surveys to the HHSC BCCS Program.

Guidance for Promotion and Outreach Plans

The plan should include the determination of the priority population, a recruitment work plan and in-reach and outreach methods.

Grantees should have many materials and resources to promote community awareness. Grantees must develop and maintain relationships with local partners and collaborators who can help recruit the priority population.

Grantees must include in their outreach plan how they plan to implement strategies to enroll clients in BCCS and raise community awareness of BCCS and MBCC in each of the counties within the grantee’s designated service area. This includes the following activities:

• identify priority populations in the community to receive information;
• identify the populations at highest risk for developing breast and cervical cancer;
• provide health education and social support;
• help reduce participant barriers to accessing clinical services;
• establish relationships with internal and external partners to reach eligible clients in the priority populations;
• establish relationships with clinic sites that offer other HHSC programs such as the Family Planning Program, Primary Health Care Program, and Healthy Texas Women to increase cross-program referrals, coordination and service provision;
• link and connect participants to partner clinics for breast and cervical cancer screening;
• educate partners, such as subrecipients, other health care providers, community organizations, and coalitions about Medicaid for Breast and Cervical Cancer (MBCC) and how to appropriately refer a non-BCCS diagnosed client for MBCC screening;
• track participants from community through screening completion;
• educate clients diagnosed with breast or cervical cancer about MBCC eligibility requirements and how to apply for services;
• provide information to each eligible woman in her primary language;
• provide access to information that is linguistically appropriate and available to the visually and hearing impaired;
• conduct outreach activities specifically for program-eligible women 30 and older who have never been screened or not screened within the last 10 years through the program; and
• collect information that describes how clients learned about BCCS and entering data into Med-IT^® with the Learned of Program function on the enrollment screen. Refer to Appendix VII, Med-IT Learned of Program and Cycle Referral Reminder.

3530 Clinic Locator Survey

Revision 25-3; Effective Sept. 1, 2025

Each fiscal year, grantees must complete a Clinic Locator Survey. The survey must be completed within 10 calendar days from the date information is requested by HHSC.

This survey provides HHSC with current clinic location information. Responses are used to update the Healthy Texas Women website Find a Doctor search function.

Grantees must also notify HHSC of any changes made to their clinic information within 30 days of the change. To update this information, request link to the Clinic Information Survey by emailing the HHSC BCCS Program.

It may take up to 30 days for changes to be found on the Healthy Texas Women website.

Revision 25-3; Effective Sept. 1, 2025

Note: Incomplete MBCC applications must not be submitted to BCCS.

MBCC Application (H1034)

Verify presumptive eligibility has been met:

• Verify client is under 65.
• Verify client household income is the same as or less than 200 percent of the Federal Poverty Level (FPL).
• Client must complete Form 1065.
• Verify the client does not have creditable insurance coverage. Creditable coverage is health care coverage that covers treatment for breast and cervical cancer. This includes current enrollment in Medicaid or Medicare Part A, Part B, or Part A and B. Note: If the woman is enrolled in the Healthy Texas Women (HTW) Program when she is diagnosed, she will be disenrolled from HTW and enrolled in MBCC by Medicaid eligibility staff.
• Verify client has a valid Texas mailing address.
• Verify client is a US citizen or qualified immigrant.
• Verify the client has a final biopsy-confirmed report for the qualifying diagnosis. Preliminary or temporary reports of qualifying diagnoses are not accepted.
• Verify analysis of all biopsies was performed by a U.S. CLIA-certified laboratory. Review Appendix II, Medicaid for Breast and Cervical Cancer (MBCC) Guidelines.
• Verify the client needs active treatment for cancer. If it was more than six months since the client’s diagnosis, ensure the client has recent provider notes or treatment plan indicating the need for treatment.

Answer all questions and fill in every blank on the H1034 as follows:

• Verify the client’s legal name, date of birth and Social Security number are correct. The name on Form H1034 must match the name on the client’s Social Security card or legal identification. If the names differ, grantees must provide clarification.
• List the months the client has unpaid bills. Note: MBCC only covers unpaid medical bills for services received after the person’s breast and cervical cancer diagnosis date. The client can call 2-1-1 for help with medical assistance before their diagnosis.
• Client may list an authorized representative. This representative cannot be a person from the BCCS grantee site.
• Verify presumptive eligibility has been met and check Yes for grantee certification.
• Verify the date of diagnosis is documented. The date of diagnosis is the specimen collection date, and is typically on the pathology report, operative record or procedure note.
• The BCCS grantee representative who is helping the client complete the application, identified as the BCCS case manager on Form H1034, must sign and date the application.
• Do not mark in the HHSC Agency Use Only section.

Attach copies of the following supporting documents:

• the final pathology report with the biopsy-confirmed, qualifying diagnosis and with no highlighting;
• recent treatment plan or progress notes, if the pathology report is older than six months;
• to support a metastatic or recurrent cancer diagnosis, send:
  • final biopsy-confirmed report of the original breast or cervical cancer diagnosis; and
  • diagnostic reports such as CT scan and biopsy report which indicate the disease is compatible with or consistent with an original qualifying breast or cervical cancer diagnosis.
    • for example, a diagnosis such as metastatic adenocarcinoma consistent with the prior breast primary;
    • many metastatic or recurrent cancers may look the same. The primary does not need to be explicitly diagnosed;
• certification of identity, U.S. citizenship or legal immigrant status; or
• copy of insurance card or letter or explanation of benefits from insurance company, if the client’s insurance is expired, terminated or does not cover cancer treatment.

Do not send bills, tax forms or other financial statements or information to HHSC.

Grantees retain proof of income in the client record and document financial eligibility in Med-IT®.

Verification of Citizenship and Identity

As part of Public Law 109-171, Deficit Reduction Act of 2005, people who declare to be a U.S. citizen or nationals of the U.S. must provide evidence of citizenship when they apply for or receive, Medicaid benefits. The documented verification must establish citizenship and identity. The Medicaid citizenship and qualified immigrant rules apply to MBCC. To be eligible for Medicaid, a person must be a U.S. citizen or a qualified immigrant.

Citizenship guidelines and verification requirements are in the Texas Works Handbook: A-300, Citizenship.

If an applicant states she is a citizen or legal immigrant, the  grantee indicates on the last page of Form H1034, Medicaid for Breast and Cervical Cancer, she is presumptively eligible. If the grantee or health provider is uncertain if a woman meets citizenship and eligible immigrant requirements, the completed Form H1034 should be submitted for processing and determination. Include any citizenship or immigration documents the woman provides. If an applicant states she does not meet citizenship requirements, an MBCC application should not be submitted.

Grantee may call 2-1-1 or 877-541-7905 for help with client eligibility and citizenship determination, or email HHSC Centralized Benefit Services (CBS) for more information about citizenship and immigrant status.

Med-IT

Enter client details and patient navigation in Med-IT® as follows:

• Make sure enrollment status is correct:
  • Active — client received BCCS services before the cancer diagnosis.
  • MBCC Referred-In — client never received BCCS services, was diagnosed by a non-BCCS provider and was referred in for MBCC application only.
• Make sure the navigation module is complete.
• Bill with the appropriate patient navigation code.

Processing the H1034

Fax or securely email the H1034 to BCCS at 512-776-7203 or MBCCApps@hhs.texas.gov.

When the application is received, BCCS program staff:

• request more information if needed; and
• nurse consultants review and send the H1034 to CBS.

Note: HHSC does not help with or collect documents for MBCC applications following submission to CBS.

The status of a client’s application is documented in the client’s Med-IT® record under enrollment notes when an application has been received and when it was sent to CBS for final eligibility determination. If there are no notes in the client’s enrollment record after three business days, you may send an email to MBCCApps@hhs.texas.gov. Use only the last four digits of the client Med-IT® identification number in the subject line. Exclude protected health information.

MBCC Application Status and Medicaid Number

Clients may call 211 for their application status and Medicaid number.

Revision 25-3; Effective Sept. 1, 2025

Guidelines for Determination of Qualifying Diagnosis

Texas Breast and Cervical Cancer Services (BCCS) provides the following guidance to health care providers and grantees to facilitate their determination of qualifying diagnoses for Medicaid for Breast and Cervical Cancer (MBCC). Analysis of all biopsies must be performed by a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory.

Cervical Cancer Qualifying Diagnoses

Qualifying precancerous cervical diagnoses must be biopsy-confirmed*:

• High-grade dysplasia
• High-grade squamous intraepithelial lesion (HSIL)
• Cervical intraepithelial Neoplasia (CIN) 2/3 or (CIN) 3
• Carcinoma in situ
• Adenocarcinoma in situ

Qualifying malignancies of the cervix must be biopsy-confirmed*:

• Adenocarcinoma
• Adenoid cystic carcinoma
• Adenosquamous carcinoma
• Glassy cell carcinoma
• Invasive cervical cancer
• Invasive endocervical adenocarcinoma
• Invasive neoplasm
• Malignant neoplasia
• Melanoma
• Sarcoma
• Small cell carcinoma
• Squamous cell carcinoma

*Cervical biopsy or endocervical sampling that have a qualifying pre- cancerous diagnosis or cervical malignancy qualify as biopsy confirmed.

Breast Cancer Qualifying Diagnoses

Qualifying breast cancer diagnoses must be biopsy-confirmed. On the pathology report, the diagnosis or the description of the specimen or both, may include at least one of the following phrases: breast cancer, breast carcinoma or breast malignancy.

Examples of most of breast cancer types are:

Ductal Carcinomas

• Comedo
• Cribriform
• Ductal carcinoma in situ (DCIS)
• Infiltrating
• Inflammatory
• Invasive
• Medullary
• Mucinous (colloid)
• Papillary or Micropapillary
• Scirrhous
• Tubular

Lobular Carcinoma*

• Invasive
• Infiltrating

Nipple Carcinoma

• Paget’s disease

Other Carcinomas

• Adenoid cystic carcinoma
• All Phyllodes tumors
• Any biopsy-proven malignancy identified in a biopsy of either breast
• Apocrine
• Carcinoma, NOS (not otherwise specified)
• Carcinoma with endocrine differentiation
• Metaplastic
• Primary lymphoma
• Sarcoma
• Secretory
• Undifferentiated carcinoma

*A diagnosis of lobular carcinoma in situ (LCIS) is not considered a qualifying pre-cancerous or breast cancer diagnosis for referral to MBCC.
 
For a medical condition to qualify as a breast cancer, the medical record documentation, such as the operative report or procedure note, must state:

• that a biopsy was taken from at least one breast; and
• a pathology report for that biopsy must confirm the diagnosis of a qualifying malignant lesion.

The pathology report does not need to describe the malignancy as definitively representing a breast primary. A malignancy identified on at least one biopsy of the breast must be clear from the medical record documentation.

Metastatic Breast and Cervical Cancers

Consider a Medicaid application for clients with cancers believed to be metastatic from the breast or cervix, if a diagnosis is made based only on the metastatic tumor and if:

• no more diagnostic workup is planned before treatment is initiated; and
• treatment will proceed on the assumption that the primary source is breast or cervix, whether or not a primary tumor has been identified.

The medical record documentation must clearly state that the primary source is believed to be breast or cervix and that treatment will start based on that assumption. Terms such as compatible with and consistent with a breast or cervical cancer are acceptable. For example, a diagnosis such as metastatic adenocarcinoma consistent with a breast primary is acceptable.

For clients who present with cancers metastatic to the breast or cervix, malignancy diagnosed in a biopsy taken from a breast or from the cervix constitutes a qualifying diagnosis.

In cases where a grantee or subrecipient is unsure about a cancer diagnosis, follow these first steps:

• Review the guidelines for determination of qualifying diagnosis.
• If the diagnosis is unclear, consult with their medical director or physician and provider staff about the diagnosis.  

Grantees should not submit a diagnosis to HHSC for evaluation before submitting an MBCC application.

Pathology Specimens

Pathology specimens, original slides, collected and evaluated outside the U.S must be reviewed by a U.S. CLIA-certified lab to determine a qualifying diagnosis. The BCCS program and the client cannot be billed for the reading and interpretation of the specimen submitted to a U.S. CLIA lab.

A specimen may be transported either by the client or by a lab to another lab.

Need Treatment

A person is considered to need treatment for breast or cervical cancer if after the initial screen under BCCS or the initial period of eligibility, their treating health professional determines that:

• Definitive treatment for breast or cervical cancer is needed, including treatment of a precancerous condition or an early-stage cancer, and including diagnostic services as necessary to determine the extent and proper course of treatment.
• More than routine diagnostic services or monitoring services for a precancerous breast or cervical condition are needed.

Clients receiving hormonal treatment or breast reconstruction are considered to be receiving treatment and may remain eligible for MBCC benefits if Medicaid paid for the client’s initial treatment. Clients with triple negative receptor breast cancer (TNRBC) receiving active disease surveillance are also considered to be receiving treatment and may remain eligible for MBCC benefits if MBCC paid for active treatment.

Active disease surveillance, for the purposes of determining eligibility for MBCC, periodically monitors disease progression to quickly treat cancerous and precancerous conditions that arise from the presence of a previously diagnosed breast or cervical cancer. Disease surveillance is not considered an active treatment for new applicants.

Revision 25-3; Effective Sept. 1, 2025

Patient Education and Support

Clinic Information

Evidenced-Based Interventions and Strategies

Revision 25-3; Effective Sept. 1, 2025

BCCS Program Information

Medicaid for Breast and Cervical Cancer (MBCC) Information

Revision 26-2; Effective March 1, 2026

Breast and Cervical Cancer Services Policy Manual, Monthly Income Standard Based on 2026 Federal Poverty Level (FPL) - (PDF)

Revision 25-3; Effective Sept. 1, 2025

• BCCS Billing Guideline (PDF)

Revision 24-2; Effective Sep. 20, 2024

• Med-IT® Learned of Program and Cycle Referral Reminder (PDF)

Revision 26-2; Effective March 1, 2026

Revision 26-1; Effective Jan. 8, 2026

Revision 25-3; Effective Sept. 1, 2025

Forms

The following forms were revised in the Breast and Cervical Cancer Services Policy Manual:

Revision 25-2; Effective March 1, 2025