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
"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
