Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 3 › Subtitle 14 - CANCER CONTROL › Chapter 10.14.04 - Breast Cancer Program › Section 10.14.04.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Annual gross income" means the total
				  amount of income received by the applicant and, if applicable, the applicant's
				  spouse, each year from all sources before taxes are withheld.
(2) "Applicant" means an individual who has
				  applied to receive services under this chapter.
(3) "Biennial" means once every other
				  year.
(4) "Breast and Cervical
				  Cancer Program" means the program that is:
(a)
				  Administered by:
(i) A local health
				  department; or
(ii) A private
				  entity that contracts with the Department to render services in Baltimore City
				  and Calvert County under the Breast and Cervical Cancer Program;
(b) Established for the early
				  detection of breast and cervical cancer; and
(c) Funded by:
(i) The federal Centers for Disease Control
				  and Prevention;
(ii) The Breast
				  Cancer Program under Health-General Article, §20-116, Annotated Code of
				  Maryland; or
(iii) Both.
(5) "Breast Cancer
				  Program" means the program created by Health-General Article, §20-116,
				  Annotated Code of Maryland, to provide:
(a) At
				  least biennial screening mammograms and clinical breast examinations to
				  low-income, underinsured and low-income, uninsured women 40 years old through
				  49 years old;
(b) Annual screening
				  mammograms and clinical breast examinations to low-income, underinsured and
				  low-income, uninsured women 50 years old or older; and
(c) Diagnosis and treatment for individuals
				  who are identified by the Breast Cancer Program as being in need.
(6) "Clinical breast examination"
				  means a physical examination of the breast performed by a health care
				  professional for the purpose of detecting breast cancer.
(7) "Contract" means the written agreement
				  between a local health department and a health care provider for the provision
				  of breast cancer services.
(8)
				  "Copayment" means the set amount of money that an individual who is enrolled in
				  a health insurance plan is responsible for paying each time the individual
				  receives a medical service after the deductible, if applicable, has been
				  paid.
(9) "Deductible" means a
				  specific sum of money that an individual who is enrolled in a health insurance
				  plan is required to pay before the individual's health insurance plan
				  reimburses the individual or the individual's medical provider for covered
				  medical services received.
(10)
				  "Department" means the Maryland Department of Health and Mental
				  Hygiene.
(11) "Diagnosis" means a
				  histopathologic finding of breast cancer in a biopsy specimen.
(12) "Eligible individual" means an applicant
				  who meets the requirements of Regulation .03 of this chapter.
(13) "Enrollee" means an eligible individual
				  who has been accepted into the Breast Cancer Program.
(14) "Free-standing ambulatory surgical
				  center" means a facility that:
(a) Provides
				  ambulatory surgical services;
(b)
				  Is physically separate from a hospital or hospital grounds;
(c) Is certified by Medicare to provide
				  ambulatory surgical services in Maryland or a jurisdiction bordering Maryland
				  under the laws of that jurisdiction; and
(d) Complies with COMAR
				  10.09.42.02B and
				  .03B.
(15) "Home health
				  services provider" means a public or private agency, organization, or part of
				  an agency or organization licensed in Maryland or a jurisdiction bordering
				  Maryland that:
(a) Meets one of the following
				  licensure requirements:
(i) If the provider is
				  a home health agency located in Maryland, the provider is licensed under
				  Health-General Article, Title 19, Subtitle 4, Annotated Code of
				  Maryland;
(ii) If the provider is a
				  home health agency located in a jurisdiction bordering Maryland, the provider
				  is legally authorized to provide home health services under the laws of that
				  jurisdiction;
(iii) If the provider
				  is part of a hospital or related institution located in Maryland, the provider
				  is licensed under Health-General Article, Title 19, Subtitle 3, Annotated Code
				  of Maryland; or
(iv) If the
				  provider is an individual who has a contractual agreement with the Department
				  to provide skilled nursing care to eligible individuals, the individual is a
				  nurse who is licensed under Health Occupations Article, Title 8, Subtitle 3,
				  Annotated Code of Maryland, to practice registered nursing;
(b) Provides nursing or physical
				  therapy services in the home; and
(c) Meets the requirements for participation
				  in Medicare.
(16)
				  "Hospital" means an institution which is located:
(a) In Maryland, that is:
(i) Subject to the provisions of
				  Health-General Article, Title 19, Subtitle 3, Annotated Code of Maryland;
				  and
(ii) Licensed pursuant to COMAR
				  10.07.01; or
(b) In a
				  jurisdiction bordering Maryland, that is licensed pursuant to applicable
				  standards established by the jurisdiction in which the hospital is
				  located.
(17) "Local
				  health department" means a governmental entity that provides public health
				  services on behalf of a county in Maryland or Baltimore City.
(18) "Mammogram" means an X-ray examination
				  of the breast to detect breast cancer that uses equipment:
(a) Specifically dedicated for mammography,
				  including:
(i) X-ray tubes;
(ii) Filters;
(iii) Compression devices;
(iv) Screens;
(v) Films; and
(vi) Cassettes; and
(b) That is designed to deliver an average
				  radiation exposure of less than one rad mid-breast with two views for each
				  breast.
(19) "Medical
				  Assistance" means the program that:
(a)
				  Provides comprehensive medical and other health-related care for eligible
				  individuals; and
(b) Is
				  administered by the State under Title XIX of the Social Security Act,
				  42 U.S.C. §
													1396.
(20) "Medical laboratory" means a laboratory
				  that:
(a) Examines tissue specimens in
				  connection with the diagnosis, treatment, or control of human disease or the
				  assessment of human health or nutritional or medical conditions; and
(b) Is in compliance with the applicable
				  license requirements for a medical laboratory providing services for Maryland
				  residents including, but not limited to the requirements:
(i) For Medicare certification;
(ii) Set forth in Health-General Article,
				  Title 17, Annotated Code of Maryland;
(iii) Set forth in COMAR 10.10.01-10.10.08;
				  and
(iv) Of the federal Clinical
				  Laboratories Improvement Act,
				  42 U.S.C. §
														263a.
(21) "Medical supply company" means a
				  provider of disposable medical supplies or durable medical equipment that, to
				  the extent required by law, is licensed and legally authorized to practice or
				  deliver services in Maryland or in a jurisdiction bordering Maryland under the
				  laws of that jurisdiction.
(22)
				  "Medicare" means the medical insurance program administered by the federal
				  government under Title XVIII of the Social Security Act,
				  42 U.S.C. §
												1395.
(23) "Nurse anesthetist" means a registered
				  nurse who is:
(a) Certified as a nurse
				  anesthetist in Maryland or a jurisdiction bordering Maryland under the laws of
				  that jurisdiction; and
(b)
				  Currently collaborating with an anesthesiologist or other physician who is
				  licensed to practice medicine:
(i) In
				  Maryland as prescribed by COMAR 10.27.06; or
(ii) In a jurisdiction bordering Maryland
				  under the laws of that jurisdiction.
(24) "Nurse practitioner" means a registered
				  nurse who is certified:
(a) By the Maryland
				  Board of Nursing to engage in the activities specified in COMAR 10.27.07;
				  or
(b) As a nurse practitioner in a
				  jurisdiction bordering Maryland under the laws of that jurisdiction.
(25) "Participating medical
				  provider under the Breast and Cervical Cancer Program" means a health care
				  provider who has entered into a written agreement with a local health
				  department or the private entity that contracts with the Department to render
				  services in Baltimore City and Calvert County under the Breast and Cervical
				  Cancer Program to provide breast cancer services to an enrollee.
(26) "Participating medical provider under
				  the Reimbursement for Breast and Cervical Cancer Diagnosis and Treatment
				  Program" means any of the following:
(a) A
				  physician who meets the requirements of COMAR
				  10.14.02.04A;
(b) A nurse practitioner who meets the
				  requirements of COMAR
				  10.14.02.05A;
(c) A nurse anesthetist who meets the
				  requirements of COMAR
				  10.14.02.06A;
(d) A physical therapist who meets the
				  requirements of COMAR
				  10.14.02.07A;
(e) A pharmacy that meets the requirements of
				  COMAR 10.14.02.08A;
(f) A hospital that meets the requirements of
				  COMAR 10.14.02.09A;
(g) A medical supply company that meets the
				  requirements of COMAR
				  10.14.02.10A;
(h) A home health service provider that meets
				  the requirements of COMAR
				  10.14.02.11A;
(i) A medical laboratory that meets the
				  requirements of COMAR
				  10.14.02.12A;
				  or
(j) A free-standing ambulatory
				  surgical center that meets the requirements of COMAR
				  10.14.02.13A.
(27) "Pharmacy" means
				  an establishment or institution that holds a permit to provide pharmacy
				  services under Health Occupations Article, Title 12, Subtitle 4, Annotated Code
				  of Maryland.
(28) "Physical
				  therapist" means an individual who is licensed or registered to practice
				  physical therapy:
(a) In Maryland under
				  Health Occupations Article, Title 13, Subtitle 3, Annotated Code of Maryland;
				  or
(b) In a jurisdiction bordering
				  Maryland under the laws of that jurisdiction.
(29) "Physician" means an individual who is
				  licensed to practice medicine:
(a) In Maryland
				  under Health Occupations Article, Title 14, Subtitle 3, Annotated Code of
				  Maryland; or
(b) In a jurisdiction
				  bordering Maryland under the laws of that jurisdiction.
(30) "Recipient of service" means an enrollee
				  who has received a covered service under this chapter.
(31) "Registered nurse" means an individual
				  who is licensed to practice registered nursing:
(a) In Maryland under Health Occupations
				  Article, Title 8, Subtitle 3, Annotated Code of Maryland; or
(b) In a jurisdiction bordering Maryland
				  under the laws of that jurisdiction.
(32) "Reimbursement for Breast and Cervical
				  Cancer Diagnosis and Treatment Program" means the program operated by the
				  Department to pay for breast and cervical cancer diagnostic and treatment
				  procedures for eligible women under COMAR 10.14.02.
(33) "Resident" means an individual who is
				  currently residing in Maryland.
(34) "Screening" means a medical test to
				  detect cancer.
(35) "Surgical
				  consult" means a consultation with a surgeon for advice on the recommended
				  follow-up of the results of screening tests that are not considered
				  normal.
(36) "Treatment" means the
				  medical management and care of a patient for breast cancer.
(37) "Ultrasound" means a medical test in
				  which high frequency sound waves are used to make an image of a specific area
				  of the breast to determine if a breast lump is a fluid-filled cyst or a solid
				  mass.