DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Prevention Services Division
6 CCR 1015-11
STATE BOARD OF HEALTH
RULES FOR THE BREAST AND CERVICAL CANCER SCREENING PROGRAM 

1.1  DEFINITIONS
(1)	“ADVISORY BOARD” MEANS THE SEVEN (7) MEMBER BOARD APPOINTED BY THE EXECUTIVE DIRECTOR OF THE DEPARTMENT THAT SHALL RECOMMEND GUIDELINES FOR THE SERVICES OF THE PROGRAM 
(2)	"BOARD" MEANS THE STATE BOARD OF HEALTH.
(3)	“BREAST AND CERVICAL CANCER MEDICAID TREATMENT PROGRAM” MEANS THE MEDICAID PROGRAM ADMINISTERED BY THE COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING TO PROVIDE MEDICAL ASSISTANCE TO ELIGIBLE PERSONS IN ACCORDANCE WITH THE PROVISIONS OF THE FEDERAL "BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT OF 2000".
(4)	“BREAST AND CERVICAL CANCER SCREENING PROGRAM” MEANS THE BREAST AND CERVICAL CANCER SCREENING PROGRAM IN THE DEPARTMENT. 
(5)	“DEPARTMENT" MEANS THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT.
(6)	"DIAGNOSTIC SCREENING" MEANS THE USE OF PROCEDURES INCLUDING PHYSICAL EXAMINATIONS, RADIOLOGIC IMAGING, SURGICAL TECHNIQUES, AND ANY NEW TECHNOLOGIES APPROVED BY THE BOARD FOR DETECTING WHETHER ABNORMALITIES OF THE BREAST AND CERVIX ARE MALIGNANT OR BENIGN.
(7)	"FUND" MEANS THE BREAST AND CERVICAL CANCER SCREENING FUND ESTABLISHED IN SECTION 25-4-1503, C.R.S. 
(8)	“GUIDELINES FOR THE SERVICES” MEANS THE CRITERIA USED FOR SCREENING BASED ON AGE, CLINICAL FINDINGS, PATIENT AND PATIENT’S FAMILY HISTORY.
(9)	“REFERRAL SERVICE” MEANS ASSISTING WOMEN FOR WHOM FURTHER EXAMINATION OR TREATMENT IS INDICATED IN COMPLETING THE RECOMMENDED, MEDICALLY INDICATED, FOLLOW-UP DIAGNOSTIC, TREATMENT AND/OR RESCREENING PROCEDURES. 
(10)	"SCREENING" MEANS THE CONDUCT OF PHYSICAL EXAMINATIONS, VISUAL INSPECTIONS, OR OTHER MEDICAL TESTS EXCLUSIVELY FOR THE PURPOSE OF ASCERTAINING THE EXISTENCE OF ANY PHYSIOLOGICAL ABNORMALITY THAT MIGHT BE INDICATIVE OF THE PRESENCE OF DISEASE. "SCREENING" INCLUDES DIAGNOSTIC SCREENING SERVICES.
1.2  PROGRAM GOALS AND SERVICES 
(1)	PROGRAM GOALS.  THE GOAL OF THE BREAST AND CERVICAL CANCER SCREENING PROGRAM IS TO HELP IMPROVE ACCESS TO SCREENING FOR BREAST AND CERVICAL CANCER BY PROVIDING SCREENING WHERE IT IS NOT OTHERWISE READILY AVAILABLE FOR REASONS OF COST OR DISTANCE TO SUITABLE MEDICAL FACILITIES AMONG UNDERSERVED WOMEN AND TO REDUCE BREAST AND CERVICAL CANCER MORTALITY THROUGH THE PROMOTION OF COMPLIANCE WITH ROUTINE SCREENING GUIDELINES.
(2)	PROGRAM SERVICES.  
(A)	ALLOWABLE FUND PURPOSES.  THE FUND SHALL BE USED BY THE DEPARTMENT FOR THE FOLLOWING PURPOSES:
(i)	TO CREATE AND  DEVELOP OF A BREAST AND CERVICAL CANCER SCREENING PROGRAM, UNDERTAKEN BY PRIVATE CONTRACT FOR SERVICES OR OPERATED BY THE DEPARTMENT, THAT WILL IMPROVE THE AVAILABILITY OF BREAST AND CERVICAL CANCER SCREENING AND WHICH MAY INCLUDE THE PURCHASE, MAINTENANCE, AND STAFFING OF A TRUCK, A VAN, OR ANY OTHER VEHICLE SUITABLY EQUIPPED TO PERFORM BREAST AND CERVICAL CANCER SCREENING;
(ii)	TO MAKE SUCH SCREENING FOR BREAST AND CERVICAL CANCER AVAILABLE TO PERSONS WHO ARE AT OR BELOW TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY LEVEL AND WHO ARE AT LEAST FORTY YEARS OF AGE BUT LESS THAN SIXTY-FIVE YEARS OF AGE;
(iii)	TO PROVIDE SUCH FURTHER BREAST AND CERVICAL CANCER DIAGNOSTIC SCREENING SERVICES, AS MAY BE INDICATED; OR
(iv)	TO CREATE AND OPERATE A REFERRAL SERVICE FOR THE BENEFIT OF WOMEN FOR WHOM FURTHER EXAMINATION OR TREATMENT IS INDICATED BY THE BREAST AND CERVICAL CANCER SCREENING.
(B)	GUIDELINES FOR SCREENING SERVICES.
(i)	SCREENING PROCEDURES SERVICES SHALL BE PROVIDED FOR PERSONS WHO ARE AT OR BELOW TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY LEVEL AND WHO ARE AT LEAST FORTY YEARS OF AGE BUT LESS THAN SIXTY-FIVE YEARS OF AGE.
(ii)	CLINICAL BREAST EXAMS SHALL BE PROVIDED TO ALL WOMEN THAT MEET THE ELIGIBILITY CRITERIA IN SECTION 1.2(2)(B)(I).  
(iii)	PELVIC EXAM AND PAPANICOLAOU (PAP) TEST SHALL BE PROVIDED TO ALL WOMEN THAT MEET THE ELIGIBILITY CRITERIA IN SECTION 1.2(2)(B)(I) WITH A CERVIX ACCORDING TO ACCEPTED INTERVALS, AND FOR WOMEN WHO HAVE HAD A SUPRACERVICAL HYSTERECTOMY (WOMEN WHO STILL HAVE A CERVIX) AND THOSE POST-HYSTERECTOMY FOR CONDITIONS RELATED TO CERVICAL NEOPLASIA.  IF A WOMAN IS UNCERTAIN AS TO WHETHER SHE HAS A CERVIX OR WHETHER HER HYSTERECTOMY WAS RELATED TO CERVICAL NEOPLASIA, SHE MAY RECEIVE A PELVIC EXAM AND PAP TEST.
(iv)	EXCEPT AS PROVIDED IN SUBPARAGRAPH (V) OF THIS SUBSECTION, MAMMOGRAPHY WILL BE PROVIDED TO ALL WOMEN WHO ARE AT OR BELOW TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY LEVEL AND WHO ARE FIFTY YEARS OF AGE BUT LESS THAN SIXTY-FIVE YEARS OF AGE. 
(v)	MAMMOGRAPHY WILL BE PROVIDED TO WOMEN WHO ARE AT OR BELOW TWO HUNDRED FIFTY PERCENT OF THE FEDERAL POVERTY LEVEL AND WHO ARE FORTY YEARS OF AGE BUT LESS THAN FIFTY YEARS OF AGE WHO HAVE:
(a)	SYMPTOMS OR FINDINGS ON CLINICAL BREAST EXAM SUSPICIOUS FOR CANCER;
(b)	A PERSONAL HISTORY OF BREAST CANCER; OR
(c)	A HISTORY OF BREAST CANCER IN A PREMENOPAUSAL FIRST DEGREE RELATIVE, E.G., MOTHER, SISTER, AUNT.   
(C)	GUIDELINES FOR DIAGNOSTIC PROCEDURES 
(i)	DIAGNOSTIC PROCEDURES SHALL BE PROVIDED FOR WOMEN THAT MEET THE ELIGIBILITY CRITERIA IN SECTION 1.2(2)(B)(I) WHO HAVE AN ABNORMAL SCREENING TEST RESULT(S).  CLINICAL GUIDELINES FOR DIAGNOSTIC PROCEDURES SHALL BE ESTABLISHED BY THE DEPARTMENT IN CONSULTATION WITH THE COLORADO WOMEN’S CANCER CONTROL INITIATIVE MEDICAL ADVISORY COMMITTEE; AND CLINICAL EXPERTS IN BREAST AND CERVICAL CANCER DIAGNOSIS AND TREATMENT.  
(ii)	DIAGNOSTIC PROCEDURES SHALL BE  PROVIDED ON AN OUTPATIENT BASIS. 
(D)	REFERRAL FOR TREATMENT.  REFERRALS FOR TREATMENT SHALL BE PROVIDED TO ALL WOMEN THAT MEET THE ELIGIBILITY CRITERIA IN SECTION 1.2(2)(B)(I) WHO ARE DIAGNOSED WITH CANCER OR PRECANCEROUS MODERATE (CINII) OR SEVERE (CINIII) CERVICAL DYSPLASIA.  ELIGIBILITY FOR THE COLORADO BREAST AND CERVICAL CANCER MEDICAID TREATMENT PROGRAM WILL BE DETERMINED FOR ALL WOMEN DIAGNOSED WITH CANCER/PRECANCER.  THOSE DETERMINED ELIGIBLE WILL BE PRESUMPTIVELY ENROLLED IN THE COLORADO BREAST AND CERVICAL CANCER MEDICAID TREATMENT PROGRAM AND DIRECTED TO COMPLETE AND SUBMIT A COLORADO MEDICAID APPLICATION. WOMEN WHO ARE NOT ELIGIBLE FOR MEDICAID WILL BE GIVEN REFERRALS TO APPROPRIATE RESOURCES FOR MEDICAL TREATMENT.