Effective: December 1, 2011 |
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03.45.30.10ar7 - Presumptive Eligibility Providers for MA-BC (Archive) |
Archived: January 1, 2012 |
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 cancer or cervical cancer, including precancerous conditions.
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 |
Altru Clinic |
Crookston |
Austin Medical Center |
Austin |
Bloomington Public Health/Sage Women's Clinic |
Bloomington |
Broadway Medical Center |
Alexandria |
Essentia Health Walker |
Walker |
Family Tree Clinic |
St. Paul |
Glacial Ridge Health System |
Glenwood |
Glencoe Regional Health Services |
Glencoe |
Gundersen Clinic, Ltd. |
LaCrosse, WI |
HCMC Whittier Clinic Hennepin County Medical Center |
Minneapolis |
Innovis Health Care |
Fosston |
Lake City Medical Center |
Wabasha |
Lake Superior Community Health Center |
Duluth |
Lakewood Clinic/Greater Staples Hospital |
Staples |
Madelia Parkview Clinic |
Madelia |
Mayo Clinic |
Rochester |
Mid-Minnesota Family Medicine Center |
St. Cloud |
Migrant Health Service, Incorporated Sandra Rangel, Bonnie Raddatz, Thare Ilift, Lori Boike, Mary T. Stetzel |
Wilmar |
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 |
Sanford Health |
Jackson |
Sanford Clinic - Pelican Rapids |
Pelican Rapids |
St. Cloud Hospital |
St. Cloud |
St. Croix Family Medical Clinic Leon Nesvacil, Milan Za |
Stillwater |
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 |