104160. (a) The State Department of Health Services shall develop
and maintain the Breast and Cervical Cancer Treatment Program to
expand and ensure quality breast and cervical cancer treatment for
low-income uninsured and underinsured individuals who are diagnosed
with breast or cervical cancer.
(b) To implement the program, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
does not claim federal financial reimbursement. The utilization of
the Medi-Cal program's fiscal intermediary shall not be subject to
Chapter 3 (commencing with Section 12100) of Part 2 of Division 2 of
the Public Contract Code. Contracts to implement the program entered
into by the department with entities other than the Medi-Cal program'
s fiscal intermediary shall not be subject to Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code.
104161. For the purposes of this article, the following definitions
shall apply:
(a) "Covered conditions" means breast or cervical cancer.
(b) "Breast cancer" includes primary, recurrent, and metastatic
cancers of the breast, including, but not limited to, infiltrating or
in situ.
(c) "Cervical cancer" includes all primary, recurrent, and
metastatic cancers of the cervix, including, but not limited to,
infiltrating or in situ, as well as cervical dysplasia.
(d) "Period of coverage" means the period of time beginning when
an individual is made eligible under this article for a covered
condition and shall not exceed the period of time the individual's
eligibility for treatment services for a covered condition concludes,
as described in Section 104161.1.
(e) "Treatment services" means those health care services, goods,
supplies, or merchandise medically necessary to treat the covered
condition or conditions with which the individual made eligible under
this article has been diagnosed.
(f) "Uninsured" means not covered for breast or cervical cancer
treatment services by any of the following:
(1) No cost full scope Medi-Cal.
(2) Medicare.
(3) A health care service plan contract or policy of disability
insurance.
(4) Any other form of health care coverage.
(g) "Underinsured" means either of the following:
(1) Covered for breast or cervical cancer treatment services by
any health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f), but the sum of the individual's insurance
deductible, premiums, and expected copayments in the initial 12-month
period that breast or cervical cancer treatment services are needed
exceeds seven hundred fifty dollars ($750).
(2) Covered by share-of-cost or limited scope Medi-Cal, if the
individual is not otherwise eligible for treatment services under the
Medi-Cal program pursuant to Section 14007.71 of the Welfare and
Institutions Code.
104161.1. (a) When an individual is made eligible for treatment
services under this article due to a diagnosis of breast cancer, the
period of coverage shall not exceed 18 months. After 18 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
(b) When an individual is made eligible for treatment services
under this article due to a diagnosis of cervical cancer, the period
of coverage shall not exceed 24 months. After 24 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
104162. An individual shall be eligible to receive treatment
services pursuant to this article provided that all of the following
criteria are met:
(a) The individual is a resident of California.
(b) The individual is uninsured or underinsured.
(c) The individual, who meets the income standards described in
subdivision (d), was screened for breast or cervical cancer by a
provider or entity participating in the Centers for Disease Control
and Prevention breast and cervical cancer early detection program
established under Title XV of the Public Health Service Act (42
U.S.C. Sec. 300k et seq.) in accordance with requirements of Section
1504 of that act (42 U.S.C. Sec. 300n) and needs treatment for breast
or cervical cancer.
(d) As determined by the provider performing the screening and
diagnosis, the individual has family income at or below 200 percent
of the federal poverty level.
(e) The individual has filed a completed application for
eligibility for treatment services under the Medi-Cal program
pursuant to Section 14007.71 of the Welfare and Institutions Code,
and has been found ineligible for benefits under that section.
104162.1. When an individual is underinsured, as defined in
subdivision (g) of Section 104161, the department shall be the payer
of second resort for treatment services. To the extent necessary for
the individual to obtain treatment services under any health care
insurance listed in paragraph (2), (3), or (4) of subdivision (f) of
Section 104161, the department may do the following:
(a) Pay for the individual's breast or cervical cancer copayments,
premiums, and deductible.
(b) Provide only treatment services not otherwise covered by any
health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f) of Section 104161.
104162.2. For the purposes of establishing eligibility for
treatment services under this article, breast or cervical cancer
screens performed by providers or entities not described in
subdivision (c) of Section 104162 may be used only to the same extent
the screens are used by the Medi-Cal program for the purpose of
determining eligibility pursuant to Section 14007.71 of the Welfare
and Institutions Code, as approved by the federal Health Care
Financing Administration.
104163. The department shall provide for breast cancer and cervical
cancer treatment services pursuant to this article at the level of
funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the
department for this purpose. These treatment services shall not be
deemed to be an entitlement.
104160. (a) The State Department of Health Services shall develop
and maintain the Breast and Cervical Cancer Treatment Program to
expand and ensure quality breast and cervical cancer treatment for
low-income uninsured and underinsured individuals who are diagnosed
with breast or cervical cancer.
(b) To implement the program, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
does not claim federal financial reimbursement. The utilization of
the Medi-Cal program's fiscal intermediary shall not be subject to
Chapter 3 (commencing with Section 12100) of Part 2 of Division 2 of
the Public Contract Code. Contracts to implement the program entered
into by the department with entities other than the Medi-Cal program'
s fiscal intermediary shall not be subject to Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code.
104161. For the purposes of this article, the following definitions
shall apply:
(a) "Covered conditions" means breast or cervical cancer.
(b) "Breast cancer" includes primary, recurrent, and metastatic
cancers of the breast, including, but not limited to, infiltrating or
in situ.
(c) "Cervical cancer" includes all primary, recurrent, and
metastatic cancers of the cervix, including, but not limited to,
infiltrating or in situ, as well as cervical dysplasia.
(d) "Period of coverage" means the period of time beginning when
an individual is made eligible under this article for a covered
condition and shall not exceed the period of time the individual's
eligibility for treatment services for a covered condition concludes,
as described in Section 104161.1.
(e) "Treatment services" means those health care services, goods,
supplies, or merchandise medically necessary to treat the covered
condition or conditions with which the individual made eligible under
this article has been diagnosed.
(f) "Uninsured" means not covered for breast or cervical cancer
treatment services by any of the following:
(1) No cost full scope Medi-Cal.
(2) Medicare.
(3) A health care service plan contract or policy of disability
insurance.
(4) Any other form of health care coverage.
(g) "Underinsured" means either of the following:
(1) Covered for breast or cervical cancer treatment services by
any health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f), but the sum of the individual's insurance
deductible, premiums, and expected copayments in the initial 12-month
period that breast or cervical cancer treatment services are needed
exceeds seven hundred fifty dollars ($750).
(2) Covered by share-of-cost or limited scope Medi-Cal, if the
individual is not otherwise eligible for treatment services under the
Medi-Cal program pursuant to Section 14007.71 of the Welfare and
Institutions Code.
104161.1. (a) When an individual is made eligible for treatment
services under this article due to a diagnosis of breast cancer, the
period of coverage shall not exceed 18 months. After 18 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
(b) When an individual is made eligible for treatment services
under this article due to a diagnosis of cervical cancer, the period
of coverage shall not exceed 24 months. After 24 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
104162. An individual shall be eligible to receive treatment
services pursuant to this article provided that all of the following
criteria are met:
(a) The individual is a resident of California.
(b) The individual is uninsured or underinsured.
(c) The individual, who meets the income standards described in
subdivision (d), was screened for breast or cervical cancer by a
provider or entity participating in the Centers for Disease Control
and Prevention breast and cervical cancer early detection program
established under Title XV of the Public Health Service Act (42
U.S.C. Sec. 300k et seq.) in accordance with requirements of Section
1504 of that act (42 U.S.C. Sec. 300n) and needs treatment for breast
or cervical cancer.
(d) As determined by the provider performing the screening and
diagnosis, the individual has family income at or below 200 percent
of the federal poverty level.
(e) The individual has filed a completed application for
eligibility for treatment services under the Medi-Cal program
pursuant to Section 14007.71 of the Welfare and Institutions Code,
and has been found ineligible for benefits under that section.
104162.1. When an individual is underinsured, as defined in
subdivision (g) of Section 104161, the department shall be the payer
of second resort for treatment services. To the extent necessary for
the individual to obtain treatment services under any health care
insurance listed in paragraph (2), (3), or (4) of subdivision (f) of
Section 104161, the department may do the following:
(a) Pay for the individual's breast or cervical cancer copayments,
premiums, and deductible.
(b) Provide only treatment services not otherwise covered by any
health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f) of Section 104161.
104162.2. For the purposes of establishing eligibility for
treatment services under this article, breast or cervical cancer
screens performed by providers or entities not described in
subdivision (c) of Section 104162 may be used only to the same extent
the screens are used by the Medi-Cal program for the purpose of
determining eligibility pursuant to Section 14007.71 of the Welfare
and Institutions Code, as approved by the federal Health Care
Financing Administration.
104163. The department shall provide for breast cancer and cervical
cancer treatment services pursuant to this article at the level of
funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the
department for this purpose. These treatment services shall not be
deemed to be an entitlement.
104160. (a) The State Department of Health Services shall develop
and maintain the Breast and Cervical Cancer Treatment Program to
expand and ensure quality breast and cervical cancer treatment for
low-income uninsured and underinsured individuals who are diagnosed
with breast or cervical cancer.
(b) To implement the program, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
does not claim federal financial reimbursement. The utilization of
the Medi-Cal program's fiscal intermediary shall not be subject to
Chapter 3 (commencing with Section 12100) of Part 2 of Division 2 of
the Public Contract Code. Contracts to implement the program entered
into by the department with entities other than the Medi-Cal program'
s fiscal intermediary shall not be subject to Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code.
104161. For the purposes of this article, the following definitions
shall apply:
(a) "Covered conditions" means breast or cervical cancer.
(b) "Breast cancer" includes primary, recurrent, and metastatic
cancers of the breast, including, but not limited to, infiltrating or
in situ.
(c) "Cervical cancer" includes all primary, recurrent, and
metastatic cancers of the cervix, including, but not limited to,
infiltrating or in situ, as well as cervical dysplasia.
(d) "Period of coverage" means the period of time beginning when
an individual is made eligible under this article for a covered
condition and shall not exceed the period of time the individual's
eligibility for treatment services for a covered condition concludes,
as described in Section 104161.1.
(e) "Treatment services" means those health care services, goods,
supplies, or merchandise medically necessary to treat the covered
condition or conditions with which the individual made eligible under
this article has been diagnosed.
(f) "Uninsured" means not covered for breast or cervical cancer
treatment services by any of the following:
(1) No cost full scope Medi-Cal.
(2) Medicare.
(3) A health care service plan contract or policy of disability
insurance.
(4) Any other form of health care coverage.
(g) "Underinsured" means either of the following:
(1) Covered for breast or cervical cancer treatment services by
any health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f), but the sum of the individual's insurance
deductible, premiums, and expected copayments in the initial 12-month
period that breast or cervical cancer treatment services are needed
exceeds seven hundred fifty dollars ($750).
(2) Covered by share-of-cost or limited scope Medi-Cal, if the
individual is not otherwise eligible for treatment services under the
Medi-Cal program pursuant to Section 14007.71 of the Welfare and
Institutions Code.
104161.1. (a) When an individual is made eligible for treatment
services under this article due to a diagnosis of breast cancer, the
period of coverage shall not exceed 18 months. After 18 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
(b) When an individual is made eligible for treatment services
under this article due to a diagnosis of cervical cancer, the period
of coverage shall not exceed 24 months. After 24 months, the
individual's eligibility for treatment services for the cancer
condition that made this individual eligible concludes.
104162. An individual shall be eligible to receive treatment
services pursuant to this article provided that all of the following
criteria are met:
(a) The individual is a resident of California.
(b) The individual is uninsured or underinsured.
(c) The individual, who meets the income standards described in
subdivision (d), was screened for breast or cervical cancer by a
provider or entity participating in the Centers for Disease Control
and Prevention breast and cervical cancer early detection program
established under Title XV of the Public Health Service Act (42
U.S.C. Sec. 300k et seq.) in accordance with requirements of Section
1504 of that act (42 U.S.C. Sec. 300n) and needs treatment for breast
or cervical cancer.
(d) As determined by the provider performing the screening and
diagnosis, the individual has family income at or below 200 percent
of the federal poverty level.
(e) The individual has filed a completed application for
eligibility for treatment services under the Medi-Cal program
pursuant to Section 14007.71 of the Welfare and Institutions Code,
and has been found ineligible for benefits under that section.
104162.1. When an individual is underinsured, as defined in
subdivision (g) of Section 104161, the department shall be the payer
of second resort for treatment services. To the extent necessary for
the individual to obtain treatment services under any health care
insurance listed in paragraph (2), (3), or (4) of subdivision (f) of
Section 104161, the department may do the following:
(a) Pay for the individual's breast or cervical cancer copayments,
premiums, and deductible.
(b) Provide only treatment services not otherwise covered by any
health care insurance listed in paragraph (2), (3), or (4) of
subdivision (f) of Section 104161.
104162.2. For the purposes of establishing eligibility for
treatment services under this article, breast or cervical cancer
screens performed by providers or entities not described in
subdivision (c) of Section 104162 may be used only to the same extent
the screens are used by the Medi-Cal program for the purpose of
determining eligibility pursuant to Section 14007.71 of the Welfare
and Institutions Code, as approved by the federal Health Care
Financing Administration.
104163. The department shall provide for breast cancer and cervical
cancer treatment services pursuant to this article at the level of
funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the
department for this purpose. These treatment services shall not be
deemed to be an entitlement.
