For purposes of this chapter, the following definitions
apply:
"Abnormal screen" means a suspicion of breast
or cervical cancer or laboratory values of total cholesterol or blood glucose
and average blood pressure reading in the range defined by the CDC according to
National Heart, Lung and Blood Institute guidelines.
1. A suspicion of breast cancer includes clinical breast
examination findings of: palpable breast mass, breast dimpling, nipple
retraction, bloody nipple discharge, palpable lymph nodes around clavicle or
axilla, nipple erythema and scaliness, a mammography result of breast imaging
reporting and data systems (BI-RADS) category 4 (suspicious abnormality
suggesting need for biopsy) or category 5 (highly suggestive of malignancy)
(ICD-10 R92.0, R92.1, R92.2, R92.8), breast biopsy result of ductal cancer in
situ (ICD-10 D05.10, D05.11, D05.12), lobular cancer in situ (ICD-10 D05.00,
D05.01, D05.02) or breast or lymph node (or other) biopsy result of breast
cancer.
2. Suspicion of cervical cancer is a Pap test result of
atypical squamous cells cannot exclude high-grade squamous intraepithelial
lesions (ASC-H) (ICD-10 R87.611 or R87.621), atypical glandular cells (AGC)
(ICD-10 R87.619 or R87.629), low-grade squamous intraepithelial lesions (LSIL)
(ICD-10 R87.612 or R87.622), or high-grade squamous intraepithelial lesions
(HSIL) (ICD-10 R87.613 or R87.623), leukoplakia of the cervix (ICD-10 N88.0),
or cervical biopsy result of cervical intraepithelial neoplasia II (ICD-10
N.87.1) or III (ICD-10 D06.0, D06.1, D06.7 or D06.9), or cancer in situ (ICD-10
D06.0, D06.1, D06.7 or D06.9).
3. Abnormal value means laboratory values of total cholesterol
or blood glucose (HbA1c if diagnosed diabetic) and average blood pressure
reading in the range defined by the CDC according to National Heart, Lung and
Blood Institute guidelines.
"ACR" or "American College of
Radiology" means one of the Food and Drug Administration-recognized
accreditation bodies for minimum quality standards for personnel, equipment,
and record keeping in facilities that provide breast imaging.
"Advanced registered nurse practitioner" means
an individual licensed to practice under 655-Chapter 7.
"Alert value" means laboratory values of total
cholesterol, blood glucose or average blood pressure reading in the range
defined by the CDC according to National Heart, Lung and Blood Institute
guidelines.
"BCCPTA" or "Breast and Cervical
Cancer Prevention and Treatment Act of 2000" means a federal law that
provides each state with the option of extending Medicaid eligibility to
individuals who were diagnosed with breast or cervical cancer through the
National Breast and Cervical Cancer Early Detection Program.
"BCCT option of Medicaid" or "breast
and cervical cancer treatment option of Medicaid" means the optional
program of medical aid designed for individuals who are unable to afford
regular medical service and are diagnosed with breast or cervical precancer or
cancer through the National Breast and Cervical Cancer Early Detection Program
or through funds from family planning centers, community health centers, or
nonprofit organizations. The individuals who receive screening or services meet
eligibility requirements established by the Iowa care for yourself program. The
BCCT option of Medicaid is financed by federal and state payment sources and is
authorized by Title XIX of the Social Security Act.
"Benign" means a noncancerous condition that
does not spread to other parts of the body.
"Biopsy" means the removal of a sample or an
entire abnormality for microscopic examination to diagnose a problem. Examples
of a sampling would be a core biopsy or incisional biopsy; an example of entire
removal would be an excisional biopsy.
"BI-RADS" or "breast imaging reporting
and data systems" means a standardized reporting system for
mammography, breast ultrasound and breast magnetic resonance imaging (MRI)
reports.
"Blood glucose" means a simple sugar found in
the blood that is an important energy source in living organisms and is a
component of many carbohydrates.
"Blood pressure" means the force of blood
against the circulatory system. The systolic blood pressure is the force caused
when the heart contracts and pushes out the blood. The diastolic blood pressure
is when the heart relaxes and fills with blood.
"BMI" or "body-mass index"
means a person's weight in kilograms divided by the square of the person's
height in meters. BMI provides a reliable indicator of body fatness for most
people and is used to screen for weight categories that may lead to health
problems.
"Breast ultrasound" means an imaging technique
commonly used to screen for tumors and other breast abnormalities. The breast
ultrasound uses high-energy sound waves to produce a detailed image of the
inside of the breast.
"Cancer" means a group of diseases involving
abnormal cell growth with the potential to invade or spread to other parts of
the body.
"Carcinoma in situ" means a group of abnormal
cells found only in the place where they first formed in the body.
"Cardiologist" means a physician licensed to
practice under Iowa Code chapter 148 who specializes in the study or treatment
of the heart and its action and diseases.
"Cardiovascular disease" means a broad term
used to describe a range of diseases that affect the heart and, in some cases,
blood vessels.
"Cardiovascular disease risk factors" means
identifiable factors that make some people more susceptible than others to
cardiovascular disease. Cardiovascular disease risk factors include:
1. Obesity.
2. Physical inactivity.
3. High blood pressure.
4. High blood cholesterol.
5. Diabetes.
6. Tobacco use.
Risk factors that cannot be changed are age, gender and family
history. The more cardiovascular disease risk factors a person has increases
the person's chance of developing cardiovascular disease.
"Case management" means the IA CFY program
component that involves establishing, brokering, and sustaining a system of
available clinical and essential support services for all individuals enrolled
in the program.
"CBE" or "clinical breast
examination" means complete examination of an individual's breast and
axilla with palpation by a health care provider trained to recognize many
different types of abnormalities and warning signs.
"CDC" means the Centers for Disease Control
and Prevention of the U.S. Department of Health and Human Services, a federal
agency that conducts and supports health promotion, prevention and preparedness
activities in the United States, with the goal of improving overall public
health.
"Cholesterol" means a waxy, fat-like substance
made in the liver and other cells and found in certain foods, such as foods
from animals, for example, dairy products, eggs and meat. Types of cholesterol
are as follows:
1. Low density lipoprotein or LDL, also called "bad"
cholesterol. LDL can cause buildup, which narrows the arteries and increases
the risk of cardiovascular disease.
2. High density lipoprotein or HDL, also called "good"
cholesterol. HDL helps the body get rid of bad cholesterol in the blood. If
levels of HDL are low, risk of cardiovascular disease increases.
3. Very low density lipoprotein or VLDL. VLDL is similar to LDL
cholesterol in that it contains mostly fat and not much protein. It differs in
that VLDL carries triglycerides, whereas LDL carries mainly cholesterol.
4. Total cholesterol means the sum of the very low, low and
high density lipoproteins.
"CLIA" or "Clinical Laboratory
Improvement Acts of 1988" means the federal regulatory standards that
apply to all clinical laboratory testing performed on humans in the United
States. These standards establish minimum quality standards for personnel and
quality assurance methods that monitor patient test management and assess
quality control, proficiency testing, and personnel handling of laboratory and
pathology specimens.
"CLIA-waived tests" means simple laboratory
examinations and procedures that are cleared by the federal government for home
use, that employ methodologies that are so simple and accurate that erroneous
results would be negligible, or that pose no reasonable risk of harm to the
patient if the test is performed incorrectly.
"CMS" or "Centers for Medicare and
Medicaid Services" is a federal agency within the United States
Department of Health and Human Services that administers health care programs,
including Medicare, Medicaid, the children's health insurance program (CHIP)
and health insurance exchanges, in partnership with state governments.
"Colposcopy" means a medical procedure that
allows close examination of the surface of the cervix with a high-powered
microscope.
"Community referral" means to direct
individuals elsewhere to obtain needed information, mutual support or community
resources through help lines or other methods.
"Community resource" means a source of
information, service or expertise that is available within the community,
including respite care services, health and mental health services and other
social services.
"Cooperative agreement" means a signed
contract between the department and another party, for example, a health care
facility, which allows the department's IA CFY program to pay the health care
facility for providing services to IA CFY program participants.
"CPT" or "current procedural
terminology" means a listing of descriptive terms and identifying
codes for uniform language to report medical services and procedures performed
by qualified health care professionals and allows clinicians, statisticians,
politicians, health insurance programs, health planners and others to speak a
common language.
"Creditable coverage" means any insurance that
pays for medical bills incurred for the screening, diagnosis, or treatment of
breast and cervical cancer. Creditable coverage as described by the Health
Insurance Portability and Accountability Act of 1996 includes, but is not
limited to, group health plans or health insurance coverage consisting of
medical care under any hospital or medical service policy, health maintenance
organization, Medicare Part A or B, Medicaid, armed forces insurance, or state
health risk pool. An individual who has creditable coverage shall not be
eligible for coverage under the breast and cervical cancer treatment option of
Medicaid.
"Creditable coverage circumstances" means
those instances in which an individual has creditable coverage but is not
actually covered for treatment of breast or cervical cancer.
1. When there is a preexisting-condition exclusion or when the
annual or lifetime limit on benefits has been exhausted, an individual is not
considered to have creditable coverage for this treatment.
2. If an individual has limited coverage, such as a high
deductible, limited drug coverage, or a limited number of outpatient visits,
the individual is still considered to have creditable coverage and is not
eligible for coverage under the breast and cervical cancer treatment option of
Medicaid.
3. If an individual has a policy with a limited scope of
coverage, such as only dental, vision, or long-term care, or has a policy that
covers only a specific disease or illness, the individual is not considered to
have creditable coverage unless the policy provides coverage for breast and
cervical cancer treatment.
4. For the purposes of this program, eligibility for Indian
Health Services or tribal health care is not considered creditable coverage
(according to P.L.
107-121, the Native American Breast and Cervical
Cancer Treatment Technical Amendment Act of 2001).
"Cytology" means the branch of biology that
studies the structure and function of a cell.
"Cytopathology" means the branch of pathology
that studies and diagnoses disease on the cellular level.
"Cytotechnologist" means a laboratory
professional who studies cells and cellular abnormalities.
"Department" means the Iowa department of
public health.
"DHS" or "department of human
services" means the Iowa department of human services, a state agency
that provides a wide range of services, including health care coverage for
low-income uninsured individuals diagnosed with breast or cervical cancer or
precancer and requiring treatment.
"Diagnostic mammography" means a radiological
examination performed for clinical indications, such as breast mass(es), other
breast signs or symptoms (spontaneous nipple discharge, skin changes), or
special cases, such as a history of breast cancer with breast conservation or
augmented breasts.
"Facility" means a place where health care is
provided, including hospitals, clinics, outpatient care centers, laboratories,
and specialized care centers that have completed enrollment paperwork with the
IA CFY program.
"Family planning clinic" means a Title X
family planning program site dedicated to the provision of family planning and
related preventive health services to low-income and underserved
populations.
"FDA" or "Food and Drug
Administration" means the federal governmental body which certifies
that a breast imaging facility meets minimum quality standards for personnel,
equipment, and record keeping.
"Follow-up" means the IA CFY program component
that ensures provision of timely and adequate services for participants who
have abnormal screening results.
"Gynecologist" means a physician licensed to
practice under Iowa Code chapter 148 who specializes in treating diseases of
the female reproductive organs and providing well-woman health care that
focuses primarily on the reproductive organs.
"HbA1c" or "glycosylated
hemoglobin" means a clinical laboratory test for the purposes of
diagnosing diabetes or determining control of diabetes over the past two to
three months.
"Health care provider" means any physician,
pharmacist, advanced registered nurse practitioner, or physician assistant who
is authorized to practice by the state; who is performing within the scope of
the practice as defined by state law; and who provides care to IA CFY
program-enrolled individuals.
"IA BCCEDP" or "Iowa breast and
cervical cancer early detection program" means a comprehensive breast
and cervical cancer screening program established and funded under Title XV of
the federal Public Health Service Act and administered by the Iowa department
of public health, with the delegated responsibility of implementation and
evaluation from the CDC, Division of Cancer Prevention and Control.
"IA CFY program" or "Iowa care for
yourself program" means an integrated comprehensive breast and
cervical cancer screening program and cardiovascular risk factor screening and
intervention program administered by the Iowa department of public
health.
"IA WISEWOMAN" or "Iowa
well-integrated screening and evaluation for women across the nation"
means a cardiovascular-related risk factor screening and intervention program
to provide standard preventive screening services, including blood pressure
measurements, cholesterol testing, blood glucose testing, and lifestyle
interventions that target poor nutrition, physical inactivity, and tobacco use.
The program is authorized by the federal government and administered by the CDC
to help reduce deaths and disability from cardiovascular disease and
stroke.
"ICD-10" or "International
Classification of Disease, 10th edition" means a standardized
classification of diseases, injuries, and reasons of death, by cause and
anatomic localization, which is systematically put into a number of up to seven
digits and which allows clinicians, statisticians, politicians, health planners
and others to speak a common language, both in the United States and
internationally.
"Infrastructure" means the basic framework of
sufficient staff and adequate support systems to plan, implement, and evaluate
the components of the IA CFY program.
"In need of treatment" means that a medical or
surgical intervention is required because of an abnormal finding of breast or
cervical cancer or precancer that was determined as a result of a screening or
diagnostic procedure for breast or cervical cancer/precancer.
"Intervention" means services that promote a
cardiovascular-healthy diet and physical activity that are based on screening
results, which include blood pressure, cholesterol, blood glucose, weight,
height, personal medical history, family medical history, and health behavior
and readiness-to-change assessments.
"MAB" or "medical advisory
board" means a body that may be utilized by the IA CFY program to
offer knowledge and experience as related to the fields of expertise of the
members of the board. Duties of the MAB may include, but are not limited to,
the following:
1. Reviewing and making recommendations for clinical service
expansion.
2. Reviewing program-developed clinical protocols.
3. Providing recommendations related to other clinical and
participant-related issues.
4. Providing input related to quality assurance issues.
5. Reviewing program screening and diagnostic data.
"MDEs" or "minimum data
elements" means a set of standardized data elements used to collect
demographic and clinical information on individuals served with NBCCEDP funds.
The MDEs are reported to the CDC to evaluate whether programs are meeting
clinical standards and programmatic priorities.
"Medicaid" means a health care program that
assists low-income families or individuals in paying for doctor visits,
hospital stays, long-term medical care, custodial care costs and more; the
program is financed by federal and state payment sources and authorized by
Title XIX of the Social Security Act and administered by the Iowa department of
human services.
"Medicare" means the program of federal
payment source for health benefits, especially for the aged, which is
authorized by Title XVIII of the Social Security Act. Medicare is administered
by CMS.
"MRI" or "magnetic resonance
imaging" means a medical imaging technique used in radiology to form
pictures of the anatomy and the physiological processes of the body. MRI
scanners use strong magnetic fields, magnetic field gradients, and radio waves
to generate images of the organs in the body.
"NBCCEDP" or "National Breast and
Cervical Cancer Early Detection Program" means a program established
with the passage of the Breast and Cervical Cancer Mortality Prevention Act of
1990 (Public Law
101-354). The law authorizes the CDC to establish
a program of grants to states, tribes, and territories for increasing the early
detection of breast and cervical cancer, particularly among low-income,
uninsured, and underserved individuals.
"Nonprofit organization" means a group
organized for purposes other than generating profit and in which no part of the
organization's income is distributed to its members, directors, or officers,
except under limited circumstances.
"Oncologist" means a physician licensed to
practice under Iowa Code chapter 148 who is a specialist in treating or
studying the physical, chemical, and biologic properties and features of
neoplasms, including causation, pathogenesis, and treatment.
"Outreach" means the IA CFY program component
that involves recruiting targeted populations or individuals who never or
rarely utilize preventive health services.
"Pap test" or "Papanicolaou screening
test" means a procedure to collect cells from the cervix for
examination under a microscope. The Pap test can detect abnormal cells or
precancerous cells before cancer develops.
"Pathologist" means a physician licensed to
practice under Iowa Code chapter 148 who is a specialist who interprets and
diagnoses the changes caused by diseases in tissues and body fluids.
"Patient navigation" means an IA CFY program
component that assists individuals in overcoming barriers and facilitates
timely access to quality screening and diagnostics as well as initiation of
breast or cervical cancer treatment services.
"Pharmacist" means an individual licensed to
practice under Iowa Code chapter 155A who is able to receive or process
prescription drug orders in accordance with the pharmacy laws.
"Physician" means an individual licensed to
practice medicine and surgery or osteopathic medicine and surgery under Iowa
Code chapter 148.
"Physician assistant" means an individual who
has successfully completed an approved program and passed an examination
approved by the board or is otherwise found by the board to be qualified to
perform medical services under the supervision of a physician and is licensed
to practice under Iowa Code chapter 148C.
"Precancerous" means a condition or lesion
involving abnormal cells that are associated with an increased risk of
developing into cancer.
"Program and fiscal management" means the IA
CFY program component that includes planning, organizing, directing,
coordinating, managing, budgeting for, and evaluating program
activities.
"Quitline Iowa" means a toll-free, statewide
tobacco cessation telephone counseling hotline through which trained counselors
provide assistance in making an individualized tobacco use quit plan and
provide ongoing support through optional follow-up calls.
"Radiologist" means a physician licensed to
practice under Iowa Code chapter 148 who specializes in the branch of medicine
that diagnoses injuries and diseases using medical imaging procedures such as
X-rays, sound waves, or other types of energy.
"Rarely or never been screened" means, as
defined for the NBCCEDP, that an individual has not had cervical cancer
screening within the last 3,469 days (9.5 years) or has never been screened for
cervical cancer.
"Recruitment" means the IA CFY program
component that involves finding new individuals to enroll in the IA CFY program
for breast and cervical health services.
"Referral" means the IA CFY program component
that involves directing individuals with abnormal/alert screening results or
barriers to services to appropriate resources for follow-up action.
"Screening mammography" means the use of X-ray
of the breasts of asymptomatic individuals in an attempt to detect abnormal
lesions of the breast when they are small, nonpalpable, and confined to the
breast.
"Service delivery" means providing, either
directly or through contractual arrangements, comprehensive breast and cervical
cancer screening and cardiovascular disease and stroke risk factor screening,
diagnosis, and treatment services through tracking of screening intervals,
timeliness of diagnosis, and timeliness of treatment of individuals.
"Surgeon" means a physician licensed to
practice under Iowa Code chapter 148 who treats disease, injury, or deformity
by physical operation or manipulation.
"Surveillance" means the IA CFY program
component that involves the systematic collection, analysis, and interpretation
of health data.
"TBS" or "the Bethesda
system" means a system for reporting cervical or vaginal cytologic
diagnoses, used for reporting Pap test results.
"Triglycerides" means a type of fat that is
carried in the blood by very low density lipoproteins. Excess calories,
alcohol, or sugar in the body are converted into triglycerides and stored in
fat cells throughout the body.
