The Sage Screening Program (formerly the Minnesota Breast and Cervical Cancer Control Program -MBCCCP), is a breast and cervical cancer control program, administered by the Minnesota Department of Health (MDH), that provides free screening to low or moderate income Minnesota women who are uninsured or underinsured.
Minnesota women screened through the MDH Sage Screening Program in need of treatment for breast or cervical cancer, including precancerous conditions and early stage cancer, may be eligible for Medical Assistance coverage (MA-BC (DHS-3525) (PDF).
Minnesota Health Care Program (MHCP) providers who have signed an agreement (DHS-4786) (PDF) with MDH to participate in the Sage Screening Program. The Sage provider agreement is subject to renewal with MDH every 5 years.
Participating providers who choose to become a presumptive eligibility (PE) provider must sign the Agreement to Conduct Medical Assistance Presumptive Eligibility for Clients of the Sage Screening Program (DHS-4786) (PDF) form with the Minnesota Department of Human Services (DHS) and complete training with MDH, using the Medical Assistance for Women with Breast or Cervical Cancer presentation located on this page at MDH.
Participating PE providers with MDH determine PE based on information provided on the Sage Enrollment Form and patient’s need for treatment.
Participating providers who do not determine PE must give applicants a copy of their Sage Screening Program form and an MA-BC Application/Renewal to submit to their county agency themselves, or the provider may forward the completed forms to the county agency to determine eligibility for program MA-BC.
Refer to the links below to obtain these forms.
To be eligible for MA-BC recipient’s must:
Before determining presumptive eligibility (PE), you must verify eligibility on MN–ITS. Recipients currently eligible for any MHCP are not eligible for PE.
Participating PE providers with MDH determine PE based on information provided on the MHCP Breast and Cervical Cancer Application/Renewal form (DHS-3525) (PDF).
Participating providers must complete, sign and give the applicant the enrollee copy of the Temporary Medical Assistance Authorization Form (DHS-3525B) (PDF). This serves as proof of eligibility until eligibility is updated and she receives an MHCP membership card. Individuals found presumptively eligible may immediately receive services.
Fax to the county's designated MA-BC staff a copy of the recipient's:
MA-BC coverage for applicants with PE begins the first day of the month in which the provider determines PE. Coverage continues for a minimum of 30 days after the date of application.
The applicant must also complete and return the MA-BC Application/Renewal (DHS-3525) (PDF) form to the county agency within 30 days to determine ongoing MA-BC eligibility.
Recipient’s determined presumptively eligible may be approved for up to three months of retroactive coverage only after they are determined eligible for ongoing MA-BC. Applicants must meet all eligibility criteria in the retroactive months for MA-BC.
Refer recipients only to MHCP-enrolled providers.
The recipient must use the Temporary Medical Assistance Authorization Form (DHS-3525B) (PDF) as proof of MA-BC (DHS-3525) (PDF) presumptive eligibility until their recipient ID is available. After three business days (72 hours) MHCP providers can verify MA-BC (DHS-3525) (PDF) eligibility and obtain the recipient’s ID number using MN–ITS. MN–ITS will denote MA-BC eligibility with major program code BC.
Providers give applicants a copy of their Sage Screening Program form and the MA-BC Application/Renewal (DHS-3525) (PDF) to submit to their county agency. (Providers may also forward the completed forms to the county agency for the applicant).
MA-BC coverage begins the first day of the month of application. Retroactive MA-BC is available up to three months prior to the application month, but cannot begin prior to the month the applicant was screened. Applicants must have met all eligibility criteria for MA-BC in the retroactive months.
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All services are subject to normal prior authorization and other utilization requirements.
Refer to the MHCP Provider Manual Authorization section for authorization criteria, and documentation requirements.
Submit authorizations using MN–ITS or the MHCP Authorization Form (DHS-4695) (PDF).
All Medical Assistance covered services may be provided under this program.
For all Non-Covered services see Non-Covered Services for MA/ MinnesotaCare.
Participating PE Provider: MA providers, who participate in the MDH Sage Screening Program who choose to become a PE provider by completing training and signing an agreement with the Minnesota Department of Health (MDH)
Presumptive eligibility (PE): A short-term period of eligibility that is determined at the point of service by the participating Sage Screening Program provider. At the time a presumptive eligibility determination is made, the participating provider gives the applicant the enrollee copy of the Temporary Medical Assistance Authorization Form (DHS-3525B) (PDF). This serves as proof of eligibility until her eligibility is updated and she receives a Minnesota Health Care Programs membership card. The presumptive eligibility period begins the first day of the month that the participating provider makes the presumptive eligibility determination and continues through a minimum of 30 days after the date of application. Individuals found presumptively eligible may receive services immediately.
MS 256B.0625, subd. 13Report/Rate this page