Okla. Admin. Code § 310:566-1-7 - Criteria for certified screening provider
Physicians (M.D., D.O.), advanced practice nurses, physician assistants, and Certified Nurse Midwives who have signed a memorandum of understanding with the Oklahoma Breast and Cervical Cancer Early Detection Program can be a certified provider. The provider in signing the memorandum of understanding certifies that the woman received breast or cervix screening, was found to be in need of treatment, and meets eligibility criteria for referral to the Medicaid Breast and Cervical Cancer Treatment Program. Eligibility criteria includes that the woman is between the ages of 19 and 64, is a US Citizen or qualified alien and a resident of Oklahoma, has an income at or below 185% of the current Federal Poverty Level, has provided a social security number, does not have creditable coverage for breast or cervical cancer treatment, and has an abnormal finding following a breast or cervical cancer screening service. Suspicious findings for breast includes clinical breast exam findings of: palpable breast mass, breast dimpling, nipple retraction, bloody nipple discharge, palpable lymph nodes around clavicle or axilla, nipple erythema and scaliness, a mammography result of BiRads 4 (Suspicious Abnormality suggesting need for biopsy) or 5 (Highly Suggestive of Malignancy) (ICD 793.8), breast biopsy result of Ductal Cancer in situ, Lobular Cancer in situ (ICD 233.0), or breast or lymph node (or other) biopsy result of breast cancer. Suspicion of cervical cancer is a Pap test result of Atypical Squamous Cells (ASC), Atypical glandular cells (AGC), Low-grade squamous intraepithelial lesions (LSIL), or High-grade squamous intraepithelial lesions (HSIL) (ICD 622.1), leukoplakia of the cervix, (ICD 622.2), or cervical biopsy result of Cervical intraepithelial neoplasia II or III, or Cancer in situ (ICD 233.1). Certified screening providers need not be BCCEDP contractors, and will not be reimbursed by the BCCEDP nor by Medicaid for the screening services provided to the woman.
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