Effective: December 1, 2007 |
|
03.45.30.10ar4 - Presumptive Eligibility Providers for MA-BC (Archive) |
Archived: February 1, 2008 |
Providers who participate in the Sage Screening Program may choose to register with DHS to become presumptive eligibility providers for Medical Assistance for Breast and Cervical Cancer (MA-BC) . These health care providers have signed agreements (see DHS-4786) with DHS to conduct presumptive eligibility determinations for women who are screened through the program and who need treatment for breast or cervical cancer or a precancerous condition.
Authorized providers will approve presumptive MA-BC eligibility for a minimum of 30 days from the application date for Minnesota women who meet all of the following:
l Have been screened through the Sage Screening Program and need treatment for breast or cervical cancer, including precancerous conditions and early stage cancer.
l Have had one of the following Sage Screening Program forms completed by their provider:
n Enrollment Form.
n Return Visit Form.
n Colposcopy Program.
Note: These Minnesota Department of Health forms (completed by Sage providers' staff) do not have DHS form numbers.
l Are under age 65.
l Have no health coverage.
The following is a list of providers who are currently authorized by DHS to grant presumptive eligibility for MA-BC. If you receive an application from a provider who is not on the list, follow your agency's procedures to submit a policy question to HealthQuest.
Presumptive Eligibility Providers |
City |
Affiliated Medical Center |
Willmar |
Allina Medical Clinic |
Buffalo |
Altru Clinic |
Crookston |
Austin Medical Center |
Austin |
Bloomington Public Health/Sage Women's Clinic |
Bloomington |
Broadway Medical Center |
Alexandria |
Central Ave. Clinic |
Minneapolis |
CommonHealth Clinic |
Stillwater |
Dakota Clinic |
Walker |
ELEAH Medical Center |
Elbow Lake |
Family Tree Clinic |
St. Paul |
Fergus Falls Medical Group |
Fergus Falls |
Glacial Ridge Health System |
Glenwood |
Glencoe Regional Health Services |
Glencoe |
HCMC Family Medical Center Hennepin County Medical Center |
Minneapolis |
Lake City Medical Center |
Wabasha |
Lake Superior Community Health Center |
Duluth |
Lakewood Clinic/Greater Staples Hospital |
Staples |
Madelia Parkview Clinic |
Madelia |
Mayo Clinic |
Rochester |
Meritcare Clinic - Pelican Rapids |
Pelican Rapids |
Mid-Minnesota Family Medicine Center |
St. Cloud |
New Ulm Medical Center |
New Ulm |
Northland Ob-Gyn Associates |
Duluth |
Northpoint Health and Wellness Center |
Minneapolis |
Olmsted Medical Center |
Rochester |
Open Door Health Center |
Mankato |
Owatonna Clinic/MHS |
Owatonna |
Pipestone County Medical Center |
Pipestone |
Planned Parenthood MN/SD |
Alexandria |
Planned Parenthood MN/SD |
Burnsville |
Planned Parenthood MN/SD |
Mankato |
Planned Parenthood MN/SD |
Minneapolis |
Planned Parenthood MN/SD |
Rochester |
Planned Parenthood MN/SD |
St. Cloud |
Regina Medical Group |
Hastings |
St. Cloud Hospital |
St. Cloud |
St. Paul-Ramsey County Department of Public Health |
St. Paul |
Stevens Community Medical Center |
Morris |
United Family Practice Health |
St. Paul |
West Side Community Health Services |
St. Paul |
Western OB/GYN |
Waconia |
White Earth Health Center |
Ogema |