NEW CDP POLICY GUIDELINE CHANGES
NO NEW PATIENTS MAY BE ADDED INTO THE CDP PROGRAM FROM JANUARY 1 – JULY 1, 2010. NEW PATIENTS SHOULD BE ACCEPTED INTO CDP STARTING JULY 1, 2010 IF THEY ARE 50+ YEARS OF AGE OR OLDER.
IF A PATIENT IS 40 – 49 YEARS OF AGE AND THEY HAD THEIR BREAST EXAM BY THE END OF 2009 AND THEY WERE SIGNED UP WITH CDP BY THE END OF 2009, THEIR MAMMOGRAM WILL BE COVERED BY CDP DURING THE FIRST SIX MONTHS OF 2010. THEIR CDP CARD MUST BE VALID AT THE TIME OF THE MAMMOGRAM. THEIR CDP COVERAGE CANNOT BE RE-ISSUEED IF THEIR “VALID UNTIL” DATE HAS PASSED.
WOMEN 50+ YEARS OF AGE OR OLDER WHO WERE ENROLLED IN CDP AT THE END OF 2009 WITH A VALID CDP CARD MAY HAVE A BREAST EXAM AND MAMMOGRAM NOW AND CDP WILL PAY FOR BOTH.
CDP WILL PAY FOR DIAGNOSTIC MAMMOGRAMS ONLY IF THE PATIENT WAS ENROLLED PRIOR TO JANUARY 1ST, 2010.
FAMILY PACT (F-PACT)
THIS PROGRAM WILL PAY FOR BOTH THE BREAST EXAM AND MAMMOGRAM IF THE PATIENT IS 40 TO 55 YEARS OF AGE AND ARE STILL FERTILE (I.E., CANNOT HAVE HAD A TUBAL LIGATION (TUBES TIED) OR HYSTERECTOMY AND MUST STILL HAVE THEIR PERIODS (CANNOT BE THROUGH MENOPAUSE).
IT SHOULD ALSO BE NOTED THAT F-PACT WILL ALSO PAY FOR WOMEN WHO QUALIFY TO HAVE A PAP SMEAR, PELVIC EXAM, STD (SEXUALLY TRANSMITTED DISEASES) TESTING AND FERTILITY TESTING.
F-PACT WILL NOT PAY FOR DIAGNOSTIC MAMMOGRAMS. THOSE WOMEN IN NEED OF A DIAGNOSTIC MAMMOGRAM WILL NEED TO GO TO A COUNTY HOSPITAL/FACILITY TO GET THIS PROCEDURE DONE.
GRANT FUNDING THROUGH THE BREAST CANCER PREVENTION FUND (BCPF) & INNER IMAGES, INC.
FOR WOMEN 40 YEARS OF AGE OR OLDER WHO DO NOT QUALIFY FOR A MAMMOGRAM OR A CLINICAL BREAST BREAST EXAM FUNDED BY EITHER CDP OR F-PACT.
GRANT FUNDING PROVIDED TO INNER IMAGES BY THE BREAST CANCER PREVENTION FUND (BCPF) WILL ALLOW WOMEN TO HAVE A SCREENING MAMMOGRAM AND A CLINICAL BREAST EXAM AT NO COST TO THEM OR THE CLINIC SERVING THEM. THOSE WOMEN IN NEED OF A DIAGNOSTIC MAMMOGRAM WILL NEED TO GO TO A COUNTY HOSPITAL/FACILITY TO GET THIS PROCEDURE DONE.
CDP New Guidelines
FREQUENTLY ASKED QUESTIONS (FAQS) REGARDING NEW CDP POLICY
1. For any patient already enrolled in CDP, will they be able to continue to have their mammograms during the first 6 months of 2010?
A screening mammogram will be paid for by the CDP during the first 6 months of 2010 only if the patient enrolled in CDP prior to January 1, 2010 and is over the age of 50.
2. How will women between the age of 40 and 50 obtain a screening mammogram?
Women between the ages of 40 and 55 who are still fertile are eligible for screening mammograms, pap, pelvic, STD and fertility testing through the Family Pact program.
4. Will CDP pay for diagnostic mammograms for women aged 40-49?
CDP will only pay for diagnostic mammograms for women aged 40-49 who were already enrolled in the program prior to January 1, 2010.
5. Do women need to be enrolled before January 1, 2010 in order to continue to receive those benefits? Yes
6. If a patient has a mammogram and Birad Code 4, will CDP cover the biopsy, even if the biopsy is scheduled for after January 1, 2010? Yes
7. How does a clinic become a "qualified" F-Pact service provider and what information is required so that the procedure can be properly billed for and reimbursed?
All Medi-Cal providers are eligible F-Pact providers. We will be providing information on how to become a certified provider. In order to bill for Family Pact you will need a S dx code and the referring provider has to be family pact certified with Medi cal.
8. Can the High Risk Grant criteria be modified to include screening mammograms for women under the age of 50 due to the recent 2010 CDP Guidelines?
We have made this request and are waiting for a response.
9. Many clinics are very interested in receiving our help to transfer patients from CDP to F-Pact. What is our plan & timeframe on helping these clinics?
We will provide whatever type of help they need. We will do everything we can.
10. Is there anything else that has happened that may impact the ability of a woman in California to get a mammogram?
California residents may have to be taken care of by private grants or other foundations. Patients who have regular healthcare insurance will benefit from the recent U.S. Senate amendment mandating that all insurance companies must pay for mammograms for all women over the age of 40 without collecting a co-pay or requiring the patient to have met their deductible.
