Breast Cancer Surgery Facilities for Medicaid Recipients
In an effort to improve the quality of care delivered to Medicaid recipients diagnosed with breast cancer, the Department of Health will no longer pay for inpatient or outpatient mastectomy and lumpectomy procedures at low-volume hospitals and ambulatory surgery centers. This is an effort to ensure that Medicaid recipients receive the best care possible by having them cared for at more experienced facilities where 5 year survival rates are statistically above those of lower volume hospitals. A list of facilities approved to perform these procedures and a list of restricted facilities is provided below.
The Department will re-examine all payor breast cancer surgery volume annually and will modify the list of providers with which Medicaid will contract for such surgery accordingly. This evaluation will be performed using the Statewide Planning and Research Cooperative System (SPARCS) data. If, at some future date, a restricted facility meets the minimum threshold of 30 surgeries per year (all payer volume) the Department will reconsider allowing the facility to perform breast cancer surgery for Medicaid recipients. This surgery exclusion still allows the facility to perform diagnostic and post surgical care for Medicaid recipients with breast cancer.