The Rhode Island Women's Cancer Screening Program provides no-cost pelvic exams, Pap tests, HPV tests, clinical breast exams, and mammograms (breast x-rays) to eligible Rhode Island women. The program also covers many diagnostic tests.more
Eligible women must be enrolled in the WCSP at a participating provider office. New enrollment forms should be completed at the office visit every year when women are screened. If a client is new to your facility, have her complete an enrollment form. (This helps the Women's Cancer Screening Program track clients through the screening and follow-up process.) Each participant must be enrolled in the Women's Cancer Screening Program at a participating provider office before she is given a referral for a mammogram. The bottom line: When in doubt, enroll!
At the office visit, a women's health exam may include a Pap test, pelvic exam, HPV test, and a Clinical Breast Exam (CBE). Once enrolled, a woman can be given a referral for a mammogram. All Rhode Island radiology facilities participate in the WCSP.
Use your office name or office stamp on WCSP Enrollment and Screening Forms to indicate where the client was enrolled into the WCSP. The RED “WOMEN’S CANCER SCREENING PROGRAM” stamp must be placed on the Pap smear/ HPV requisitions, mammogram referrals, or other outside orders so that the lab or radiology facility will invoice the WCSP and not the client for services provided.
To find out if a CPT is reimbursable, refer to the current Provider Reimbursement Schedule.
Please note the following restrictions on reimbursement of Pap test following hysterectomy, endometrial biopsies, and Breast Magnetic Resonance Imaging (MRI):
As an extension of the Women's Cancer Screening Program, women may be eligible to apply for Medical Assistance (Medicaid) to cover the cost of treatment for a precancerous condition of the breast/cervix or a diagnosis of breast or cervical cancer. In order to qualify for Medical Assistance through the Women's Cancer Screening Program, a woman must:
As soon as all required forms are received, the WCSP Case Management Coordinator will meet with a representative from the Department of Human Services to determine eligibility (usually within 7 days of receipt of completed application). The Case Management Coordinator will call the provider site that initiated enrollment to let them know if the patient is enrolled in Medical Assistance and the effective date of enrollment. The WCSP fiscal staff will contact each provider site that has submitted invoices to the WCSP to inform them of the client's Medical Assistance coverage for any pending payments.
A woman with a pre-cancerous condition of the breast or cervix is eligible for Medicaid services for 4 months. A woman with a diagnosis of breast or cervical cancer is eligible for Medicaid services for one year. Prior to the end the woman’s eligibility period, the Department of Human Services will send the woman a re-determination letter. If she continues to need treatment for a precancerous condition of the breast or cervix, or breast or cervical cancer, she must have her provider complete the re-determination form and return it to Department of Human Services. If the provider confirms that treatment is needed, Department of Human Services will extend the Medical Assistance benefit until the woman completes treatment or has access to other health insurance coverage. This process will continue as long as she needs treatment, as verified by a clinician. During her eligibility period, a woman is entitled to the full scope of services available through Medical Assistance. In other words, coverage is not limited to treatment of a pre-cancerous condition or diagnosis of cancer. A woman will not be removed from Medical Assistance without prior correspondence from the Department of Human Services office.