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 26-3; Effective Sept. 1, 2026

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 Federal Poverty Level (FPL)
• be a Texas resident
• be without access to programs or benefits that provide the same services

BCCS is the payor of last resort. When a grantee is awarded multiple HHSC program grants, consult this manual for times when limited dual certification grantee billing is allowed. Grantee must seek HHSC approval for any times not clearly defined in this manual.

Other Eligibility Factors

Other eligibility factors include:

• Applicants must meet age-specific eligibility criteria for screening and diagnostic services.
• Applicants with a primary need for 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 make sure 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 policy and procedures to determine BCCS eligibility and identify people responsible for eligibility screening.  The policy must be available during monitoring visits and must address:

• acceptable documents that 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, or an HHSC-approved eligibility screening form substitute, such as in-house form, electronic form or phone interview that contains the required information for determining eligibility. Refer to Alternative Eligibility Screening Tool below.

Grantees eligibility policy must also make sure:

• client insurance status is assessed before service delivery.
• general BCCS eligibility is determined before enrollment, then annually.
• clients 65 and older are only eligible if they are unable to pay or are ineligible 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.

3220 Applying for Services

Revision 26-3; Effective Sept. 1, 2026

Screening and Eligibility Determination

Grantees must use Form 1065, Eligibility Application, or an HHSC-approved eligibility screening form substitute, such as in-house form, electronic form or phone interview that contains the required information for determining eligibility. Refer to Alternative Eligibility Screening Tool below.

The applicant must complete Form 1065. If the applicant needs help completing the form, grantees must provide knowledgeable staff to assist.

Client eligibility determination may be conducted by phone. Applicants may print the form, add a handwritten signature, scan it and email or fax the form to a grantee. Client and grantee digital signatures are allowed. A grantee may sign on behalf of an applicant if needed. If eligibility is determined over the phone, grantees must read and get the applicant’s verbal authorization to sign or initial the form 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 it.

Documenting Special Circumstances

Special circumstances may prevent an applicant from providing required documentation for verification purposes. Document these types of special circumstances on Form 1065. Special circumstances must also be documented in the Med-IT^® Data System in the notes section of the enrollment screen.

Former Military Service Members

Grantees must collect and report service member data for clients served by the BCCS program. Grantees will collect and report the service member data through Med-IT^®.

Applicants who served in any branch of the U.S. Armed Forces, Reserves or National Guard may be eligible for more benefits and services. Grantees must refer them to the Texas Veterans Portal for more information. Former female military service members must also be referred to the Texas Veterans Commission’s Women Veterans Program.

Residency

A person must be physically present within the geographic boundaries of Texas to be eligible for BCCS. There is no required 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.

Legal responsibility for support exists between:

• people who are legally married, including common-law marriage;
• a legal parent and a minor child, including unborn children; or
• a managing conservator and a minor child. A managing conservator is a person designated by a court to have daily legal responsibility for a child.

All children younger than 18 years must be counted as part of the household, including a pregnant client’s unborn children. A BCCS-eligible applicant who is a legal adult must complete Form 1065.

Grantees have 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 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 younger than 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 4 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.

To find a monthly income when income is received in lump sums at irregular intervals or at intervals longer than monthly, such as contract labor and seasonal employment, divide the total amount received over the period it is expected to cover household expenses. Convert the amount by:

• multiplying weekly income by 4.33
• multiplying income received every two weeks by 2.17
• multiplying income received twice a month by 2.0
• dividing income received annually 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

• Determine the applicant’s household size.
• Determine the applicant’s total monthly income amount.
• Divide the applicant’s total monthly income amount by the maximum monthly income amount at 100% FPL, for the appropriate household size.
• 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.

Alternative Eligibility Screening Tool – AEST

An AEST, created by the grantee may be used in place of Form 1065 with prior written approval by the BCCS program.

To apply for approval, grantees must send a request to the BCCS program mailbox. Put AEST Request in the subject line.

The HHSC BCCS program contact will send grantees an AEST Request Form to complete. Grantees must complete the form and return it to the program mailbox with the proposed AEST. 

At a minimum, the AEST must contain all required elements of Form 1065.

HHSC must review and approve before use. Grantees must use Form 1065 until they have received written approval of the proposed AEST from HHSC. The grantee must maintain and retain proof of approval. The grantee must make the approval available during Quality Assurance visits.

Once a grantee receives approval for the use of the AEST, the following requirements apply.

• Grantees must request approval from the BCCS for any revisions to their eligibility screening tool and include a copy of the revised tool.
• The AEST is only approved for use during the current grant term. If a grantee is awarded funding under a subsequent grant, the grantee must resubmit the AEST for review and written approval. This is required even if no changes have been made to the tool since the last written approval.
• Any changes made to Form 1065 that HHSC considers requirements for eligibility must be incorporated into the grantee-developed AEST. Grantees must submit their AEST with the incorporated changes within 60 calendar days after notification of a change to Form 1065 for re-review and approval.

The BCCS program reserves the right to request edits or withdraw its approval of the use of an alternate eligibility tool. The BCCS program will notify the grantee of the decision in writing and include the date the AEST must be discontinued.

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 26-3; Effective Sept. 1, 2026

Clients must not be charged copays for BCCS allowable services or 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 26-3; Effective Sept. 1, 2026

Med-IT^® users should verify if 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-ITHelpDesk@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 26-3; Effective Sept. 1, 2026

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 deliver services by telemedicine if appropriate. Those who furnish telemedicine services must follow all rules per the Texas Occupations Code 111.001. Providers also must have written policies and procedures to address:

• informed consent;
• confidentiality of the client’s clinical information;
• provision of appropriate, quality care;
• prevention of abuse and fraud in the use of telemedicine services;
• adequate supervision of health professionals who are not physicians and who provide telemedicine care;
• 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 26-3; Effective Sept. 1, 2026

The grantee must make sure advanced practice providers (APPs) maintain a properly executed prescriptive authority agreement (PAA). APP includes advanced practice registered nurses (APRN) and physician assistants (PA). The PAA must meet all the requirements of the Texas Occupations Code, Title 3, Subtitle B, Chapter 157. The PAA and any amendments must be reviewed at least annually, dated and signed by the parties to the agreement. The PAA must:

• be in writing, signed and dated by the parties to the agreement;
• state the name, address and all professional license numbers of the 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 patient emergencies;
• state the general process for communicating and sharing information between the physician and APRN or PA the physician has delegated prescriptive authority to related to the care and treatment of patients;
• designate one or more alternate physicians, if alternate physician supervision is to be used, who may:
  • provide appropriate supervision on a temporary basis per the requirements established by the PAA and the requirements of Chapter 157 of the Texas Occupation Code; and
  • participate in the prescriptive authority quality assurance and improvement plan meetings required under Section 157.0512; and
• describe a prescriptive authority quality assurance and improvement plan and specify methods to document 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.

References

• Texas Occupations Code, Title 3, Subtitle B, Chapter 157 Authority of Physicians to Delegate Certain Medical Acts
• Texas Administrative Code (TAC), Title 22, Part 11, Chapter 222 Advanced Practice Registered Nurses with Prescriptive Authority

Delegation Protocol for Advanced Practice Providers

APRNs and PAs must have delegated authority from a licensed physician to provide medical aspects of patient care. Physician delegation occurs through protocols or other written authorization. Rather than require multiple documents, delegation protocols can be included in the prescriptive authority agreement.

References

• TAC, Title 22, Part 9, Chapter 169, Subchapter A, Section 169.1(11) Protocols and Section 169.2(a)
• TAC, Title 22, Part 9, Chapter 169, Subchapter B, Section 169.5 Delegation to Physician Assistants and Advanced Nurse Practitioners
• Texas Occupations Code, Title 3, Subtitle B, Chapter 157, Subchapter B Delegation to Advanced Practice Registered Nurses and Physician Assistants
• TAC, Title 22, Part 11, Chapter 221, Section 221.13(d)(1-2) Texas Board of Nursing, Delegation Protocols or written authorization requirements for APRNs

3340 Standing Orders

Revision 26-3; Effective Sept. 1, 2026

Standing Orders (SO) include standing delegation orders, standing medical orders and written protocols. These terms are defined in the Texas Administrative Code (TAC), Title 22, Part 9, Chapter 169, Subchapter A, Section 169.1(12-14). SOs authorize a registered nurse (RN), licensed vocational nurse (LVN) or other health professional to implement specific orders for a patient with or developing a condition or symptoms. 

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

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

References

• Texas Board of Nursing Position Statements (15.5) Nurses with Responsibility for Initiating Physician Standing Orders
• TAC, Title 22, Part 9, Chapter 169, Subchapter A, Section 169.1 and 169.2(b)

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 26-3; Effective Sept. 1, 2026

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

BCCS may reimburse breast MRI along with a screening mammogram after program approval. Grantees must request approval using Form 5203, Breast MRI Prior Authorization Request. The form is returned to the grantee within 10 business days after HHSC clinical staff review.

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 prior 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:

• client’s name and another 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.

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, Breast and Cervical Diagnostic Procedure Complication Reimbursement Request, 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 26-3; Effective Sept. 1, 2026

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 any age client:

• in the absence of high-grade squamous intraepithelial lesion (HSIL), ASC-H or higher abnormality.
• 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, review 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.

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. Inpatient hospital services are excluded. 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 Form 5205, Breast and Cervical Diagnostic Procedure Complication Reimbursement Request and 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 26-3 Effective Sept. 1, 2026

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 these 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. Grantees should 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.

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 26-3; Effective Sept. 1, 2026

Patient navigation is 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:

• 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 and documentation of Med-IT ® 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 identify resources to meet client needs, including dysplasia and cancer treatment services, regardless of client ability to pay. Documents 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:

• all BCCS-enrolled clients;
• 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 (CD) management and treatment. CD recipients must not be eligible for MBCC.

Patient navigation does not include eligibility determination.

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. Services include patient navigation if she continues to meet BCCS eligibility requirements.

Requirements for Patient Navigation Compliance

Navigation of patients must meet these requirements:

• Patient navigation must include an assessment for needs and care coordination planning.
• The assessment will 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 CD, 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 with 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

MBCC applicants must be provided a needs assessment and MBCC application assistance if determined to meet presumptive eligibility. MBCC applicants who do not meet presumptive eligibility should be provided with information about available local resources. 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.

Good Faith Effort

A good faith effort is at least two documented attempts to contact and navigate a client.

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 Monthly Voucher Packet

Revision 26-3; Effective Sept. 1, 2026

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

Vouchers must be submitted each month even if there are no expenditures. Vouchers must still be submitted each month for actual expenditures of the program even if the grant limit has been reached.

3420 Financial Status Report

Revision 26-3; Effective Sept. 1, 2026

The Financial Status Report (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. The final quarter report includes all final charges and expenses associated with the program grant. Mark it as final.

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 26-3; Effective Sept. 1, 2026

Performance Indicators and Reports

Grantees are required to meet National Breast and Cervical Cancer Early Detection Program (NBCCEDP) performance measures.

The performance indicators (PIs) – separated by screening, cervical cancer diagnostic and breast cancer diagnostic – are used to assess, in part, the grantee’s effectiveness providing BCCS services. These performance measures are subject to change.

Screening indicators are:

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.

   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.

Follow-up Report – FUR

FUR summarizes pending follow-up examinations, diagnostics and treatment initiation. Diagnostic performance indicators outline specified time frames. The FUR is due no later than the 10th calendar day of each month to HHSC Med_IT Helpdesk.

Performance Indicator Report – PIR

PIR summarizes the core performance indicators and provides a snapshot of overall timeliness to diagnostics or treatment. The PIR is due no later than the 10th calendar day of each quarter 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. Grantees must submit the questionnaire linked in the MDE Calendar and Instructions. MDE questionnaires are due no later than the 10th calendar day of each quarter to HHSC Med_IT Helpdesk. 

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 Location Survey

Revision 26-3; Effective Sept. 1, 2026

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

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 to find changes on the Healthy Texas Women website.