Oklahoma Administrative Code › Title 310 - Oklahoma State Department of Health › Chapter 566 - Comprehensive Breast and Cervical Cancer Detection and Treatment › Subchapter 1 - General Provisions › Section 310:566-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
"Abnormal screen"
means a suspicion of breast or
				  cervical cancer. A suspicion of breast cancer includes clinical breast exam
				  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 BiRads 4 (Suspicious
				  Abnormality suggesting need for biopsy) or 5 (Highly Suggestive of Malignancy)
				  (ICD 793.8), breast biopsy result of Ductal Cancer in situ, Lobular Cancer in
				  situ (ICD 233.0), or breast or lymph node (or other) biopsy result of breast
				  cancer. Suspicion of cervical cancer is a Pap test result of Atypical Squamous
				  Cells (ASC), Atypical glandular cells (AGC), Low-grade squamous intraepithelial
				  lesions (LSIL), or High-grade squamous intraepithelial lesions (HSIL) (ICD
				  622.1), leukoplakia of the cervix, (ICD 622.2), or cervical biopsy result of
				  Cervical intraepithelial neoplasia II or III, or Cancer in situ (ICD
				  233.1).
"ACR"
means American College of Radiology. The
				  ACR is the FDA recognized approved accreditation body for minimum quality
				  standards for personnel, equipment, and record keeping in facilities that
				  provide mammography.
"Benign"
means a non-cancerous condition that
				  does not spread to other parts of the body.
"Bethesda System"
means a specified system of
				  reporting cervical cytology findings.
"Biopsy"
means removal of an entire abnormality
				  (excisional biopsy) or a sampling or portion of abnormality (core and
				  incisional biopsy) for microscopic examination in order to diagnose a
				  problem.
"BiRads"
means Breast Image Reporting and Data
				  System.
"Breast and Cervical Cancer Program Treatment Act
				  (BCCPTA)"
means a Medicaid plan amendment creating a new categorically
				  needy group consisting of women screened for breast and /or cervical cancer
				  under the BCCEDP and found to be in need of treatment.
"Breast carcinoma in situ"
means breast changes
				  in which malignant cells are localized and confined to breast ducts or lobules
				  and may press against adjoining breast tissue but have not penetrated or spread
				  beyond the breast.
"BSE"
means breast self-examination. This is
				  inspection and palpation of a woman's breasts by the woman herself.
"Cancer"
means a general term for more than 100
				  diseases characterized by abnormal and uncontrolled growth of cells.
"CBE"
means clinical breast examination. A
				  complete examination of the breast and axilla with palpation by a health
				  professional, including examination of the breast in both the upright and
				  supine positions.
"Case management"
means a program component of
				  the Oklahoma Breast and Cervical Cancer Early Detection Program that involves
				  establishing, brokering, and sustaining a system of available clinical and
				  essential support services for all women enrolled in the program.
"Certified provider"
means a healthcare
				  professional who has signed a memorandum of understanding with the Oklahoma
				  Breast and Cervical Cancer Early Detection Program certifying that the woman
				  received breast or cervix screening, was found to be in need of treatment, and
				  meets eligibility criteria for referral to the Medicaid Breast and Cervical
				  Cancer Treatment Program.
"CLIA"
means the Clinical Laboratory Improvement
				  Act which establishes minimum quality standards for personnel and quality
				  assurance methods which monitor patient test management and assess quality
				  control, proficiency testing and personnel handling of laboratory and pathology
				  specimens.
"Colpscopy"
means examination of the cervix with
				  a high-powered microscope.
"Creditable coverage"
means any insurance that
				  pays for medical bills incurred for the screening, diagnosis, or treatment of
				  breast and cervical cancer. Creditable coverage includes, but is not limited
				  to, group health plans, health insurance coverage consisting of medical care
				  under any hospital or medical service policy, or health maintenance
				  organization, Medicare Part A and B, Medicaid, Armed Forces Insurance, and/or
				  state health risk pool. A woman having creditable coverage will not be eligible
				  to apply for Medicaid coverage of breast and cervical cancer screening or
				  treatment.
"Creditable coverage circumstances"
means there
				  are some circumstances where a woman has creditable coverage but is not
				  actually covered for treatment of breast or cervical cancer. In an instance
				  such as pre-existing condition exclusions, or when the annual or lifetime limit
				  on benefits has been exhausted, a woman is not considered to have creditable
				  coverage for this treatment. If the woman has limited coverage, such as limited
				  drug coverage or limits on number of outpatient visits or high deductibles, the
				  woman is still considered to have creditable coverage and is not eligible to
				  apply for Medicaid coverage of breast and cervical cancer treatment. If the
				  woman has a policy with limited scope of coverage such as only dental, vision,
				  or long term care, or a policy that covers only a specific disease or illness,
				  she is not considered having creditable coverage, unless the policy provides
				  full coverage for breast and cervical cancer treatment. For the purposes of
				  this program eligibility for IHS or Tribal health care is not considered
				  creditable coverage.
"Diagnostic mammography"
means radiologic
				  examination used to evaluate a patient with a breast mass(es), other breast
				  signs or symptoms (spontaneous nipple discharge, skin changes, of special cases
				  such as a history of breast cancer with breast conservation or augmented
				  breasts).
"FDA"
means the United States Food and Drug
				  Administration. The FDA certifies that a mammography facility meets minimum
				  quality standards for personnel, equipment, and record keeping.
"Follow-up"
means a program component of the
				  Oklahoma Breast and Cervical Cancer Early Detection Program that involves a
				  system for seeking information or reviewing an abnormal condition, rescreening,
				  and/or recall for annual visits.
"Infrastructure"
means sufficient staff and
				  adequate supporting systems to plan, implement, and evaluate the program
				  components of the Oklahoma Breast and Cervical Cancer Early Detection
				  Program.
"In need of treatment"
means an abnormal screen
				  determined as a result of a screening for breast and/or cervical cancer under
				  the Oklahoma Breast and Cervical Cancer Early Detection Program.
"Medicaid"
means a combined federal and state
				  payment source for health care benefits for certain eligible women who are
				  disabled or who have dependent children. Health care benefits must be a part of
				  the state plan for health services.
"Medicare"
means a federal payment source for
				  health benefits for certain eligible women.
"Minimum data elements"
means a set of
				  standardized data elements developed by the Centers for Disease Prevention and
				  Control, Division of Cancer Prevention and Control, to ensure that consistent
				  and complete information on screening location, demographic characteristics,
				  screening results, diagnostic procedures, tracking and follow-up, and treatment
				  information are collected on women screened and/or diagnosed with federal
				  funding.
"Never screened"
means women who have never been
				  screened for breast and/or cervical cancer or who do not utilize preventive
				  health services.
"Oklahoma Breast and Cervical Cancer Early Detection
				  Program (BCCEDP)"
means a comprehensive breast and cervical cancer
				  program established and funded under Title XV of the federal Public Health
				  Service Act with delegated responsibility of implementation and evaluation to
				  the Centers for Disease Control and Prevention, Division of Cancer Prevention
				  and Control, and administered by the Oklahoma State Department of
				  Health.
"Oncologist"
means a specialist who treats or
				  studies the physical, chemical, and biologic properties and features of
				  neoplasms, including causation, pathogenesis, and treatment.
"Outreach"
means a program component of the
				  Oklahoma Breast and Cervical Cancer Early Detection Program that involves
				  recruiting high-risk populations, targeted populations or persons who never or
				  rarely utilize preventive health services.
"Pap smear"
means a screening test for the
				  detection of abnormal cells from the cervix. The Pap smear can detect abnormal
				  cells or pre-cancerous cells before cancer develops.
"Pathologist"
means a specialist in pathology; a
				  physician who practices, evaluates, or supervises diagnostic tests, using
				  materials removed from living or dead patients, and functions as a laboratory
				  consultant to clinicians, or who conducts experiments or other investigations
				  to determine the causes or nature of disease changes.
"Physician"
means any person who has completed a
				  course of medical training, has received a medical degree and is licensed by
				  the Oklahoma State Board of Medical Licensure or the Oklahoma Osteopathic Board
				  of Examiners to practice medicine.
"Pre-cancerous lesions"
means poorly
				  differentiated cells that could progress to cancer.
"Program and fiscal management"
means a program
				  component of the Oklahoma Breast and Cervical Cancer Early Detection Program
				  that conducts planning, organizing, directing, coordinating, managing,
				  budgeting, and evaluating program activities.
"Radiologist"
means a physician skilled in the
				  diagnostic and/or therapeutic use of x-rays and other forms of radiant
				  energy.
"Rarely screened"
means women who have not had
				  breast and/or cervical cancer screening within the last five (5) years.
"Referral"
means a program component of the
				  Oklahoma Breast and Cervical Cancer Early Detection Program that involves
				  directing women with abnormal screens to appropriate resources for
				  action.
"Screening mammography"
means x-ray of the
				  breasts of asymptomatic women in an attempt to detect abnormal lesions of the
				  breast when they are small, non-palpable, and confined to the breast.
"Service delivery"
means providing either
				  directly or through contractual arrangements for comprehensive breast and
				  cervical cancer services of screening, diagnosis, and treatment through client
				  tracking of screening intervals, timeliness of diagnosis and timeliness of
				  treatment.
"Surgeon"
means a physician who treats disease,
				  injury, and deformity by operation or manipulation.
"Surveillance"
means a program component of the
				  Oklahoma Breast and Cervical Cancer Early Detection Program that involves the
				  systematic collection, analysis, and interpretation of health data.
"Ultrasound of the breast"
means the use of
				  sonic energy to produce a pictorial representation of the internal structure of
				  the breast. The image is produced by pulse-echo techniques with detection and
				  display of tissue interfaces rather than densities.
Added at 22 Ok Reg 400,
				  eff 12-21-04 (emergency); Added at 22 Ok Reg 2409, eff
				  7-11-05