Current through Register Vol. 47, No. 6, September 18, 2024
(1) Program and fiscal
management shall be conducted by ensuring strategic planning, implementation,
coordination, integration, and evaluation of all programmatic activities and
administrative systems, as well as the development of key communication
channels and oversight mechanisms to aid in these processes. Program management
shall ensure that infrastructure adequately supports service
delivery.
(2) Service delivery of
specific and appropriate clinical procedures to detect breast and cervical
abnormalities and cardiovascular disease or stroke risk factors for individuals
enrolled in the IA CFY program shall be directly provided or provided through
contractual arrangements.
a. The IA CFY
program shall cover breast and cervical cancer screening and diagnostic
services including, but not limited to, the following when those services are
provided by a participating health care provider whose facility has a
cooperative agreement with the Iowa department of public health's IA CFY
program. Payment shall be based on Medicare Part B participating-provider rates
as released annually at the beginning of each calendar year.
(1) Physical examinations that include two
blood pressure measurements in addition to one or more of the following
screening services: CBE, pelvic examination, or Pap test;
(2) Height and weight measurements, when
provided in conjunction with one or more of the screening services listed in
subparagraph 8.2(2)"a"(1) above;
(3) Mammography (screening and
diagnostic);
(4) Breast ultrasound,
when used as an adjunct to mammography;
(5) Fine-needle aspiration of breast
cysts;
(6) Breast biopsies,
excisional and nonexcisional (physician charges only; hospital charges are not
covered);
(7) Colposcopy of the
cervix, with or without biopsy;
(8)
Surgical consultations for diagnosis of breast and cervical cancer;
(9) Pathology charges for breast and cervical
biopsies;
(10) Anesthesia for
program-approved CPT and ICD-10 codes (health care provider charges only;
hospital charges and supplies are not covered).
b. Breast and cervical cancer-related
services not covered by the IA CFY program include, but are not limited to, the
following:
(1) Services not related to breast
or cervical cancer screening or diagnosis;
(2) Treatment procedures and
services;
(3) Services provided by
nonparticipating providers;
(4)
Hospital charges for breast biopsies and anesthesia;
(5) Inpatient services.
c. The IA CFY program shall cover
cardiovascular disease-related services for select participants enrolled for
WISEWOMAN services for whom at least one breast or cervical cancer screening
service was paid for using federal funds. Cardiovascular disease-related
services shall include, but not be limited to, the following when a
participating health care provider that has a cooperative agreement with the
department provides those services. Payment shall be based on Medicare Part B
participating-provider rates as released annually at the beginning of each
calendar year.
(1) Physical examinations that
include two blood pressure measurements;
(2) Height and weight measurements;
(3) Fasting lipid panel that includes total
cholesterol, HDL cholesterol, LDL cholesterol, triglycerides; and
(4) Diabetes screening:
1. For an individual who has not been
diagnosed with diabetes, fasting blood glucose; and
2. For an individual who has been diagnosed
with diabetes, glycosylated hemoglobin (HbA1c).
d. Cardiovascular disease-related services
not covered by the IA CFY program include, but are not limited to, the
following:
(1) A follow-up diagnostic visit to
a health care provider if one or more screening values are in the CDC-defined
abnormal value range;
(2) Repeat
laboratory testing;
(3) Any
additional testing;
(4) Medication;
and
(5) Treatment.
e. IA CFY program cardiovascular
intervention shall be conducted as a component of the program for all
individuals who are eligible and enrolled to receive WISEWOMAN
services.
f. A health care provider
whose facility has a cooperative agreement with the IA CFY program shall be
subject to the following:
(1) The health care
provider agrees that reimbursement of procedures and services provided shall
not exceed the amount paid under Medicare Part B participating-provider rates
as released annually at the beginning of each calendar year.
(2) A mammography health care provider shall
ensure that the provider's facility has current FDA certification and ACR or
state of Iowa accreditation and is a Medicare and Medicaid-approved facility
utilizing BI-RADS and following ACR guidelines for mammography report
content.
(3) A board-certified
radiologist must be immediately available to determine selection of views and
readings when a diagnostic mammogram is performed.
(4) The health care provider shall submit
obtained cytology and pathology specimens to a CLIA-certified laboratory for
processing. The laboratory shall provide cytological reading and analysis of
cervical and vaginal Pap tests by certified/registered cytotechnologists.
Cytology (Pap) test results shall be reported using current TBS terminology.
The laboratory shall provide board-certified pathologists or experienced
certified cytotechnologists to rescreen all analyses and readings of cervical
and breast biopsies.
(5) The health
care provider shall practice according to the current standards of medical care
for breast and cervical cancer early detection, diagnosis, and
treatment.
(6) Service delivery may
be provided in a variety of settings. Service delivery, however, must include:
1. Providing screening services for specific
geographic areas;
2. Providing a
point of contact for scheduling appointments;
3. Providing age and income eligibility
screening;
4. Providing breast and
cervical cancer screening and cardiovascular disease and stroke screening to
eligible individuals;
5. Providing
referral and follow-up for individuals who have alert-value cardiovascular
disease screening results;
6.
Providing the required reporting system for screening and follow-up
activities;
7. Providing
population-based education, outreach, and recruitment activities;
8. Providing IA CFY program cardiovascular
intervention as a component of the program for all individuals eligible for and
enrolled to receive IA WISEWOMAN program services; and
9. Submitting data within 60 days of service
date to establish screening documentation.
(7) The health care provider shall ensure
compliance with this chapter and other terms and conditions included in the
cooperative agreement.
(3) Referral, tracking, and follow-up
utilizing a data system to monitor each enrolled individual's receipt of
screening/rescreening, diagnostic, and treatment procedures shall be conducted
by the IA CFY program and contracted county board of health designated agency
staff.
a. The enrolled individual shall be
notified by contracted county board of health designated agency staff of the
results of the service, whether the results are normal, benign, or
abnormal.
b. The data system shall
provide tracking of appropriate and timely clinical services following an
abnormal test result or diagnosis of cancer.
c. If the enrolled individual has an abnormal
Pap test or breast screening or an alert-value cardiovascular disease risk
factor, the health care provider shall provide the individual with a
comprehensive referral to appropriate diagnostic or treatment
services.
d. The comprehensive
referral shall be written. Follow-up shall be conducted to determine whether
services were timely, completed, or met.
(4) The IA CFY program and contracted county
board of health designated agency staff shall provide case management and shall
assist participants whose cancer or precancerous breast or cervical condition
was diagnosed through the program in obtaining needed treatment
services.
(5) IA CFY program staff
shall use quality assurance and improvement techniques including use of
established standards, systems, policies and procedures to monitor, assess and
identify practical methods for improvement of the program and its components.
a. Quality assurance tools shall include
utilizing FDA and ACR minimum standards for mammography facilities and CLIA
minimum standards for cytopathology and pathology laboratories.
b. Quality assurance measures shall
contribute to the identification of corrective actions to be taken to remedy
problems found as a result of investigating quality of care.
(6) Professional development shall
be provided by the IA CFY program and contracted county board of health
designated agency staff through a variety of channels and activities that
enable professionals to perform their jobs competently, identify needs and
resources, and contribute to ensuring that health care delivery systems provide
positive clinical outcomes.
(7)
Using a variety of methods and strategies to reach priority populations, the IA
CFY program and contracted county board of health designated agency staff shall
provide population-based public education and recruitment that involve the
systematic design and delivery of clear and consistent messages about breast
and cervical cancer and the benefits of early detection. Outreach activities
should focus on individuals who have never or rarely been screened and should
work toward the removal of barriers to care (i.e., the need for child care,
respite care, interpreter services and transportation) through collaborative
activities with other community organizations.
(8) The IA CFY program may develop coalitions
and partnerships to bring together groups and individuals that establish a
reciprocal agreement for sharing resources and responsibilities to achieve the
common goal of reducing breast and cervical cancer mortality and cardiovascular
disease and stroke mortality.
(9)
The IA CFY program shall conduct surveillance utilizing continuous, proactive,
timely and systematic collection, analysis, interpretation and dissemination of
breast and cervical cancer screening and cardiovascular disease and stroke risk
factor behaviors and incidence, prevalence, survival, and mortality rates.
Epidemiological studies shall be conducted utilizing MDEs and other data
sources to establish trends of disease, diagnosis, treatment, and research
needs. Program planning, implementation, and evaluation shall be based on the
epidemiological evidence.
(10)
Evaluation of the program shall be conducted through systematic documentation
of the operations and outcomes of the program, compared to a set of explicit or
implicit standards or objectives.
