Section 641.8.1. Definitions.

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-9 793.8), breast biopsy result of ductal cancer in situ, lobular cancer in situ (ICD-9 233.0), 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-9 795.02), atypical glandular cells (AGC) (ICD-9 795.00), low-grade squamous intraepithelial lesions (LSIL) (ICD-9 622.11 or 795.03), or high-grade squamous intraepithelial lesions (HSIL) (ICD-9 622.12 or 795.04), leukoplakia of the cervix (ICD-9 622.2), or cervical biopsy result of cervical intraepithelial neoplasia II or III (ICD-9 622.10, 622.11, 622.12, 795.03, or 795.04), or cancer in situ (ICD-9 233.1).

        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 mammography.

“Advanced registered nurse practitioner” means an individual licensed to practice under 655—Chapter 7.

“Alert value” means 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.

“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 women 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 women who are unable to afford regular medical service and are diagnosed with breast or cervical cancer through the National Breast and Cervical Cancer Early Detection Program or through funds from Susan G. Komen for the Cure. 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 reports.

“Blood pressure” means the pressure or tension of the blood within the systemic arteries, maintained by the contraction of the left ventricle, the resistance of the arterioles and capillaries, the elasticity of the arterial walls, as well as the viscosity and volume of the blood; expressed as relative to the ambient atmospheric pressure.

“BMI”  or “body-mass index”  means a number calculated from a person’s weight and height. 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 the use of high-energy sound waves that are bounced off internal tissues and make echoes to produce a pictorial representation of the internal structure of the breast.

“Cancer” means a malignant tumor of potentially unlimited growth of new cells that expand locally by invasion and systemically by metastasis.

“Carcinoma in situ” means cell changes in which malignant cells are localized and may press against adjoining tissue but have not penetrated or spread beyond their site of origin.

“Cardiologist” means a physician who specializes in the study of the heart and its action and diseases.

“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 women enrolled in the program.

“CBE”  or “clinical breast examination”  means complete examination of a woman’s breast and axilla with palpation by a health care provider, including examination of the breast in both the upright and supine positions.

“CDC” means the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.

“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 of plaque on the walls of arteries. The more LDL there is in the blood, the greater the risk of heart 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 heart 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.

“CLIA”  or “Clinical Laboratory Improvement Act of 1988”  means the law which established 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.

“Colposcopy” means a procedure that allows close examination of the surface of the cervix with a high-powered microscope.

“Community referral” means the act, action or instance of directing a participant to a community resource.

“Community resource” means a source of information, service or expertise that is available within the community.

“Cooperative agreement” means a signed contract between the department and another party, for example, a health care provider. This contract allows the department to pay the health care provider for providing services to IA CFY program participants.

“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. A woman 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 a woman 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, a woman is not considered to have creditable coverage for this treatment.

        2.            If the woman has limited coverage, such as a high deductible, limited drug coverage, or a limited number of outpatient visits, she 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 the woman 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, she 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 scientific study of cells.

“Cytopathology” means the scientific study of cells in disease.

“Cytotechnologist” means a medical technician trained in the identification of cells and cellular abnormalities.

“Department” means the Iowa department of public health.

“Diagnostic mammography” means a radiological examination performed for appropriate 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.

“FDA”  or “Food and Drug Administration”  means the federal governmental body which certifies that a mammography facility meets minimum quality standards for personnel, equipment, and record keeping.

“Follow-up” means the IA CFY program component that involves a system for seeking information about or reviewing an abnormal condition, rescreening, or recall for annual visits.

“Glucose” means a simple sugar that is an important carbohydrate in biology. Cells use glucose as a source of energy and a metabolic intermediate.

“Gynecologist” means a physician who specializes in diseases of the reproductive organs in women.

“HbA1c”  or “glycosylated hemoglobin”   means a clinical laboratory test for the purposes of monitoring blood glucose control of a participant diagnosed with diabetes.

“Health care provider” means any physician, advanced registered nurse practitioner, or physician assistant who is licensed by the state of Iowa and provides care to IA CFY program-enrolled women.

“Heart disease” means a broad term used to describe a range of diseases that affect the heart and, in some cases, blood vessels. The term is often used interchangeably with “cardiovascular disease,” which generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

“Heart disease risk factors” means identifiable factors that make some people more susceptible than others to heart disease. Heart disease risk factors include:

        1.            Being overweight.

        2.            Lack of physical activity.

        3.            High blood pressure.

        4.            High blood cholesterol.

        5.            Diabetes.

        6.            Cigarette smoking.

Risk factors that cannot be changed are age and family history. The more heart disease risk factors a person has increases the person’s chance of developing heart disease.

“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, 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 heart disease and stroke.

“ICD-9”  or “International Classification of Disease, 9th 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 six 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 under the NBCCEDP.

“Intervention” means services that promote a heart-healthy diet and physical activity and that are based on screening results, which include blood pressure, cholesterol, glucose, weight, height, personal medical history, family medical history, and health behavior and readiness-to-change assessments.

“MATF”  or “medical advisory task force”  means an advisory board 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 task force. Duties of the MATF 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 women whose screening or diagnosis was paid for with IA CFY program funds. MDEs were developed by the CDC, Division of Cancer Prevention and Control, to ensure that consistent and complete information is collected on women whose screening or diagnosis was paid for with IA CFY program funding.

“Medicaid” means the program of medical aid designed for those unable to afford regular medical service, financed by federal and state payment sources, and authorized by Title XIX of the Social Security Act.

“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.

“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 the purpose of increasing the early detection of breast and cervical cancer, particularly among low-income, uninsured, and underserved women.

“Oncologist” means a physician 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 women who never or rarely utilize preventive health services.

“Pap test” means the Papanicolaou screening test that collects 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 who is a specialist in identifying diseases by studying cells and tissues under a microscope.

“Physician” means an individual licensed to practice under Iowa Code chapter 148.

“Physician assistant” means an individual licensed to practice under Iowa Code chapter 148C.

“Precancerous” means a condition that may become, or is likely to become, 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 smoking cessation telephone counseling hotline through which trained counselors provide caller assistance in making an individualized tobacco use quit plan and provide ongoing support through optional follow-up calls.

“Radiologist” means a physician who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with X-rays, sound waves, or other types of energy.

“Rarely or never been screened” means, as defined for the NBCCEDP, that a woman has not had cervical cancer screening within the last five years or has never been screened for cervical cancer.

“Recruitment” means the IA CFY program component that involves enrolling targeted populations or women for preventive health services.

“Referral” means the IA CFY program component that involves directing women with abnormal screening results to appropriate resources for follow-up action.

“Screening mammography” means the use of X-ray of the breasts of asymptomatic women 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 heart disease and stroke risk factor screening, diagnosis, and treatment services through tracking of screening intervals, timeliness of diagnosis, and timeliness of treatment of women.

“Surgeon” means a physician 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.

“Susan G. Komen for the Cure” means an international organization with a network of volunteers working through local affiliates and Komen Race for the Cure® events to eradicate breast cancer as a life-threatening disease by advancing research, education, screening, and treatment.

“TBS”  or “the Bethesda system”  means a system that was developed to provide uniform diagnostic terminology for reporting cervical or vaginal cytologic findings to facilitate communication between the laboratory and the clinician.

“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.

“WISEWOMAN”  or “Well-Integrated Screening and Evaluation for Women Across the Nation”   means a national program that offers blood pressure, diabetes, and cholesterol risk factor screening, lifestyle intervention, and referral services in an effort to prevent cardiovascular disease.

[ARC 0059C, IAB 4/4/12, effective 5/9/12]