1. KCCSP

2. The following only applies if you are receiving grant funds from the Department for Public Health for the Kentucky Colon Cancer Screening Program.

3. Service Contract Contract must address what services are to be covered: Colonoscopy Facilities Anesthesia Removal of polyps Who is providing the prep Who is doing prep instructions

4. Service Contract cont... Language that addresses: Colonoscopy procedural report and pathology report are due to the patient navigator before payment for completed services will occur Patient will not be balance billed for any services of colonoscopy, facilities, anesthesia, removal of polyps, pathology related to polyps

5. Service Contract cont.. Language that address: Cecum reached and entered Prep quality as Excellent/Good/Fair/Poor Recommended future test cycle If a second colonoscopy is needed, it will not be paid for without the approval of State KCCSP staff.

6. Program Personnel Contract Contract must address: Patient Navigator (PN) is required to attend state sponsored trainings sessions and teleconferences related to program Required participation in site visits by state staff Program participants eligibility must be verified and documented

7. Program Personnel Contract Verify and document that program participant does not have Medicaid PN must assist the program participant to a KYNECT if they are eligible for Medicaid or for other insurance based on income

8. Program Personnel Contract The PN is to assist patient through the screening process PN is to navigate patients with abnormal screenings results or colon cancer diagnosis to additional services/navigators PN ensures that referrals, procedures, communications and follow-up occur in a timely fashion

9. Program Personnel Contract PN is to enter required information into the appropriate data system PN/local program is responsible for outreach to target population PN will assign the patient to either FIT or Colonoscopy screening based on the outcome of the eligibility and enrollment form

10. Program Personnel Contract PN will collaborate with KCP on this project The FIT Kits are to be disturbed only during a face to face encounter PN is to provide FIT Kite education PN is responsible to follow up with patients who have not completed the screening process

11. Program Personnel Contract PN is responsible for maintaining HIPPA compliance Who will over see program when PN is absent from work PN is responsible to notify patients of FIT result