D.C. Mun. Regs. tit. 29, r. 29-4301

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-4301 - ELIGIBILITY REQUIREMENTS

4301.1

A woman eligible to receive services pursuant to this Chapter shall meet all of the following requirements:

(a) Be a resident of the District of Columbia;

(b) Be at least 18 years of age, but has not attained the age of 65;

(c) Has received a screening mammogram, clinical breast exam or Pap test; or has received diagnostic services following an abnormal clinical breast exam, mammogram, or Pap test under the District of Columbia's Breast and Cervical Cancer Early Detection Program, known as Project WISH;

(d) Has received a diagnosis of breast or cervical cancer or of a pre-cancerous condition of the breast or cervix the result of the screening or diagnostic service rendered pursuant to section 4301.1(c);

(e) Be determined to need treatment for either breast or cervical cancer;

(f) Be uninsured or not otherwise covered under creditable coverage, as the term is used under the Health Insurance Portability and Accountability Act, as set forth in section 2701(c) of the Public Health Service Act (42 USC 300gg(c) );

(g) Ineligible for Medicaid benefits under any other mandatory categorically needy eligibility group; and

(h) Meets all other eligibility criteria applicable to Medicaid beneficiaries, including citizenship and alienage requirements.

4301.2

A woman determined to be eligible pursuant to the criteria set forth in section 4301.1 shall be entitled to full Medicaid benefits. Coverage shall not be limited to treatment for breast or cervical cancer.

4301.3

Consistent with Section 1902(a)(34) of the Social Security Act, eligibility for coverage may begin up to three months prior to the month in which an application was filed to receive Medicaid benefits, if as of the earlier date all other eligibility requirements are met.

4301.4

Eligibility for coverage pursuant to this chapter terminates when the course of treatment for breast or cervical cancer is completed, or when a determination has been made that the patient no longer meets the eligibility criteria set forth in section 4301.1 of these rules and is not eligible to receive Medicaid benefits under an alternate eligibility category, whichever is earlier.

4301.5

Eligibility shall not be limited to one period. A new period of eligibility and coverage shall commence each time a woman is screened in accordance with section 4301.1(c) and determined to need treatment for breast or cervical cancer, and meets all other eligibility requirements.

D.C. Mun. Regs. tit. 29, r. 29-4301

Final Rulemaking published at 50 DCR 997 (January 31, 2003)