1200, Program Authorization

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