Effective: August 1, 2007 |
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03.45.30.10ar3 - Presumptive Eligibility Providers for MA-BC (Archive) |
Archived: December 1, 2007 |
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 Completed one of the following Sage Screening Program forms:
n Enrollment form.
n Return Visit form.
n Colposcopy Program form
Note: These Minnesota Department of Health forms, which were included with Bulletin #02-21-07, Medical Assistance Coverage for Women Screened by the Minnesota Breast and Cervical Cancer Control Program, 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 |
Austin Medical Center |
Austin |
Bloomington Public Health |
Bloomington |
CommonHealth Clinic |
Stillwater |
Family Tree Clinic |
St. Paul |
Hennepin County Medical Center HCMC Family Medical Centers |
Minneapolis |
Lake Superior Community Health Center |
Duluth |
Lakewood Clinic/Greater Staples Hospital |
Staples |
Madelia Parkview Clinic |
Madelia |
Meritcare |
Pelican Rapids |
Mid-Minnesota Health Clinic |
St. Cloud |
New Ulm Medical Center |
New Ulm |
Olmsted Medical Center |
Rochester |
Owatonna Clinic/MHS |
Owatonna |
Pilot City Health Center |
Minneapolis |
Pipestone County Medical Center |
Pipestone |
Planned Parenthood of MN/SD |
Alexandria |
Planned Parenthood of MN/SD |
Burnsville |
Planned Parenthood of MN/SD |
Mankato |
Planned Parenthood of MN/SD |
Minneapolis |
Planned Parenthood - Rochester |
Rochester |
Planned Parenthood – St. Cloud |
St. Cloud |
Regina Medical Center/ Regina Medical Group |
Hastings |
St. Paul-Ramsey County Department of Public Health |
St. Paul |
West Side Community Health Services |
St. Paul |