Michigan Colorectal Cancer Early Detection Program ... Colorectal Cancer Early Detection Program (MCRCEDP)

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  • Michigan Colorectal Cancer Early Detection Program (MCRCEDP)

    Program Manual

    FY2020

    Michigan Department of Health and Human Services

    November 2019

  • Table of Contents

    Overview  Contact Information: Michigan Department of Health and Human Services 3

    MCRCEDP Program Requirements  Eligibility Requirements – Quick Reference Sheet  Eligibility Requirements – Detailed Document  Eligibility U.S. Citizenship  Minimum Program Requirements  CDC Service Quality Indicators  MCC Clinical Protocol for the Early Detection of Colorectal Cancer (CRC)  Conscious Sedation Policy (Propofol)  Inadequate Bowel Preparation Guidelines  Policy for Retention of Client Records

    4 5 7 8

    14 15 17 18 19

    Patient Navigation  Risk Assessment Script Templates  Patient Navigation  OC Light FIT Kits  MDHHS Fecal Immunochemical Test (FIT) Instructions – English

    22 28 32 34

    MCRCEDP Forms  MDHHS Agreement for Program Participation – formerly Informed Consent Form  Enrollment Form  Referral to Healthy Michigan Plan or the Health Insurance Marketplace  Michigan Tobacco Quit Line Referral Form  FIT Intake Form  Colonoscopy Intake Form  Secured Application User Agreement Access Form – MBCIS Application  Provider/Facility Form

    35 38 40 41 42 43 47 48

    MCRCEDP Provider Documents  Fax Template - Forms Tracking  Provider Claim Submission and Reimbursement  Quick Reference Sheet: Billable Codes

    49 50 51

    MCRCEDP Flowsheets, and Resources  FIT Screening Flow Chart  Colonoscopy Flow Chart (Diagnostic/Surveillance/Screening)  FIT Supply Request Form  FIT Kit Ordering Process & Expiring FIT Kits  Provider Colorectal Cancer (CRC) Resources  Client Colorectal Cancer (CRC) Resources

    52 53 54 55 56 57

    Budget Documents  Annual Budget Instructions 60

  • MDHHS Contact Information

    Michigan Department of Health and Human Services 109 W Michigan Avenue Washington Square Bldg. Cancer Section – 5th Floor

    Lansing, MI 48933 Fax: (517) 335-8752

    www.michigancancer.org/Colorectal

    Dr. Nickell M. Dixon Program Director (517) 335-9349 DixonN2@michigan.gov

    Sharde’ Burton, BS, MPH Cancer Policy & System Change Consultant (517) 373-7226 BurtonS4@michigan.gov

    Susan Harris, PhD Data Manager MI Public Hlth Institute 2390 Woodlake Drive Suite 360 Okemos, MI 48864 (517) 324-7306 SHarris@mphi.org

    Robin L. Roberts Svcs Coordination Unit Manger (517) 335-1178 RobertsR6@michigan.gov

    Kanika S. Lewis, MPH, MSW, RN Public Health Consultant (517) 335-9087 (517) 763-0290 – Fax LewisK27@michigan.gov

    Tory Doney Lay Patient Navigator, Billing & Reimbursement Specialist, and MBCIS Technical Assistance (517) 335-8854 (517) 763-0290 – Fax DoneyT@michigan.gov

    http://www.michigancancer.org/Colorectal http://www.michigancancer.org/Colorectal mailto:DixonN2@michigan.gov mailto:DixonN2@michigan.gov mailto:BurtonS4@michigan.gov mailto:BurtonS4@michigan.gov mailto:SHarris@mphi.org mailto:SHarris@mphi.org mailto:RobertsR6@michigan.gov mailto:RobertsR6@michigan.gov mailto:HamiltonD1@michigan.gov mailto:HamiltonD1@michigan.gov mailto:DoneyT@michigan.gov mailto:DoneyT@michigan.gov

  • Colorectal Cancer Screening Program Eligibility Quick Reference Sheet

    The Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides colorectal cancer (CRC) screening services in limited areas to eligible men and women:

    • Ages 50-64 • Low income (≤ 250% of the Federal Poverty Level) • Who have no symptoms • Who are underinsured and uninsured: • Colonoscopy for average and increased-risk clients • Fecal Immunochemical Test (FIT), optional for average risk clients

    o Insured/underinsured clients may be eligible for the MCRCEDP if they have high out- of-pocket costs for a colonoscopy.

    o Clients who are not currently insured by the Healthy Michigan Plan are eligible for the MCRCEDP.

    Average Risk Clients will be screened by colonoscopy or optional FIT, an at-home collection of stool. • Clients with a positive FIT found through the MCRCEDP will be referred for a diagnostic colonoscopy. • Average risk clients with positive (+) FIT results obtained from outside the program, may be eligible for

    services. o Contact an agency for additional details as these enrollments will need to be approved by

    MDHHS.

    Increased Risk Clients will be screened by colonoscopy.

    High Risk Clients are Not Eligible for the MCRCEDP. This includes men and women with: • Significant ongoing gastrointestinal symptoms. • Genetic, clinical or family history that places them at high risk for CRC.

    Contact these agencies for MCRCEDP Enrollment

    • District Health Department #10: (231) 876-3826 (Kalkaska, Crawford, Manistee, Wexford, Missaukee, Mason, Lake, Oceana, Newaygo, Montcalm, Mecosta Counties)

    • Huron County Health Department: (989) 269-3323 (Huron, Sanilac, Tuscola, Bay, Saginaw, St Clair Counties)

    • Health Department of Northwest Michigan: (231) 547-7677 (Antrim, Charlevoix, Emmet, Otsego Counties)

    • Grand River Gastroenterology: (616) 752-5297 (Grand Rapids/surrounding area, Kent County)

    • Karmanos Cancer Institute & ACCESS Community Health Center: (313) 216-2206 or (248) 304-2301 (Macomb, Oakland & Wayne Counties)

    • Integrated Health Partners: (269) 425-7135 (Calhoun County)

    # ppl in house

    Annual Income

    # ppl in house

    Annual Income

    1 $31,225 2 $42,275 3 $53,325 4 $64,375 5 $75,425 6 $86,475

  • Colorectal Cancer Screening Program Eligibility

    The Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides colorectal (CRC) screening services to program eligible men and women who meet the following criteria:

    • Asymptomatic, aged 50-64 years o Average risk for CRC - screened by colonoscopy or optional at-home fecal

    immunochemical test (FIT) o Increased risk for CRC – must be screened by colonoscopy o Positive FIT /FOBT from outside the program – Average risk clients with a positive FIT

    or FOBT performed outside of MCRCEDP may be enrolled in the program on a limited basis. Contact the Michigan Department of Health and Human Services (MDHHS) for authorization prior to enrolling these patients in the program for a diagnostic colonoscopy.

    • Low income (< 250% of the Federal Poverty Level) • Uninsured or underinsured:

    o No health insurance: Enroll eligible clients who are not currently insured. o Inadequate health insurance: Enroll eligible clients who have high out-of-pocket CRC

    screening expenses.  For the underinsured, call the insurance company to verify deductible or out-

    of-pocket expenses. Document insurance deductible on the enrollment form. Once CRC services are provided, the client’s insurance must be billed first with an Explanation of Benefit demonstrating a coverage gap. CDC funds must be used as the “funds of last resort” to pay for CRC services.

     Clients enrolled in the Healthy Michigan Plan (HMP) are not eligible for MCRCEDP screening services.

    Referrals for Insurance:

    • All clients

  • o All clients interested in obtaining health insurance through the marketplace should be referred to a Patient Navigator at Enroll Michigan or the Health Insurance Marketplace.

    o Referrals to the Marketplace must be documented on the MCRCEDP enrollment form and in MBCIS.

    Referrals to Primary Care:

    • If the client has no current provider, refer him/her to a PCP as a part of the enrollment process.

    INELIGIBLE CLIENTS High Risk People who are symptomatic and those at high risk for colorectal cancer are NOT eligible for screening or surveillance services through the MCRCEDP. A process must be in place to refer clients who are ineligible for the MCRDEDP for additional services and/or evaluation. People at high risk include those with:

    1. A genetic, clinical diagnosis or family history or suspicion of familial polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC/Lynch Syndrome).

    2. A history of inflammatory bowel disease, ulcerative colitis or Crohn’s disease. 3. Significant gastrointestinal symptoms including, but not limited to rectal bleeding, bloody

    diarrhea, blood in the stool within the past 6 months, prolonged change in bowel habits such as diarrhea or constipation for more than two weeks that has not been clinically evaluated

    4. Abdominal pain 5. Unintentional weight loss of 10% or more of starting body weight 6. Symptoms of bowel obstruction (e.g., abdominal distension, nausea, vomiting, severe

    constipation).

    Referral of Ineligible Clients: • This includes:

    o High risk clients o Individuals who require CRC screening, but do not meet MCRCEDP eligibility

    requirements (due to age, income or other eligibility criteria) o Individuals who may not benefit from CRC screening.

    • All clients, who require screening but are not eligible for the MCRCEDP, must be referred to a PCP for CRC screening and/or diagnostic services utilizing community resources as needed.

    • All uninsured clients who are not eligible for the MCRCEDP should be referred to a Patient Navigator to assist with enrollment in the HMP and the Health Insurance Marketplace.

    http://enrollmichigan.com/ http://enrollmichigan.com/ https://www.healthcare.gov/health-insurance-ma