Iowa Administrative Code › Agency 641 - Public Health Department › Chapter 8 - Iowa Care for Yourself (IA CFY) Program › Rule 641-8.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
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.