# COMAR Title 10 — Maryland Department of Health

## Subtitle 14 — Cancer Control

### Chapter 06 — Cigarette Restitution Fund Program

**Authority:** Health-General Article, §§13-1001—13-1014 and 13-1101—13-1119, Annotated Code of Maryland

**Administrative History:** Effective date: January 15, 2007 (34:1 Md. R. 32)

**Administrative History:** Regulation .01 amended effective March 26, 2018 (45:6 Md. R. 320)

**Administrative History:** Regulation .02B amended effective February 27, 2017 (44:4 Md. R. 254); March 26, 2018 (45:6 Md. R. 320)

**Administrative History:** Regulation .03 amended effective February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .03A amended effective March 26, 2018 (45:6 Md. R. 320)

**Administrative History:** Regulation .04B amended effective February 27, 2017 (44:4 Md. R. 254); March 26, 2018 (45:6 Md. R. 320)

**Administrative History:** Regulation .05 repealed and new Regulation .05 adopted effective February 27, 2017 (44:4 Md. R. 254)

**Administrative History:** Regulation .06 repealed and new Regulation .06 adopted effective February 27, 2017 (44:4 Md. R. 254)

#### Regulation .01 Scope.

*COMAR 10.14.06.01*

This chapter establishes the financial eligibility criteria for an uninsured or underinsured individual to receive cancer treatment services and tobacco treatment products under the Cigarette Restitution Fund Program.

#### Regulation .02 Definitions.

*COMAR 10.14.06.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Applicant” means an individual who has applied to receive cancer treatment services or tobacco treatment products under this chapter.

  (2) “Cancer Prevention, Education, Screening, and Treatment Program” means the program created by Health-General Article, §§13-1101—13-1119, Annotated Code of Maryland, to provide cancer prevention, education, screening, and treatment services in Maryland.

  (3) “Cancer treatment service” means a medical service, medical supply, or medical equipment provided to:

    (a) Treat cancer, including:

      (i) Surgery;

      (ii) Chemotherapy;

      (iii) Radiation therapy;

      (iv) Hormonal therapy;

      (v) Home health services; and

      (vi) Medical supplies and medical equipment;

    (b) Treat medical complications resulting from cancer screening or treatment;

    (c) Treat other comorbid conditions in order to treat cancer; and

    (d) Serve the needs of cancer patients for palliative or end-of-life care.

  (4) “Department” means the Maryland Department of Health.

  (5) “Federal poverty level” means the amount of household income by family size that a family needs for basic necessities as determined by the federal poverty guidelines, as amended, which are updated annually in the Federal Register by the U.S. Department of Health and Human Services.

  (6) “Gross annual household income” means the total income of the applicant and any member of the applicant’s household received each year from all sources before taxes are withheld or deductions are taken.

  (7) “Local health department” means a governmental entity in a county in Maryland that provides public health services.

  (8) “Maryland Children’s Health Insurance Program” means the program administered by Medical Assistance to provide health insurance coverage to eligible children younger than 19 years old in Maryland.

  (9) “Medical Assistance” means the program that:

    (a) Provides comprehensive medical and other health-related care for eligible individuals; and

    (b) Is administered by the State under Title XIX of the Social Security Act, 42 U.S.C. §§1396—1396v.

  (10) “Medicare” means the medical insurance program administered by the federal government under Title XVIII of the Social Security Act, 42 U.S.C. §1395 et seq.

  (11) “Statewide academic health center” means:

    (a) The University of Maryland Medical Group;

    (b) The Johns Hopkins Institutions;

    (c) The organization designated by the Department as stipulated by Health-General Article, §13-1115, Annotated Code of Maryland; or

    (d) One or more of the organizations in §B(11)(a)—(c) of this regulation.

  (12) “Tobacco product” means cigarettes, cigars, pipe tobacco, smokeless tobacco, and any other product containing tobacco in any form.

  (13) “Tobacco treatment product” means all Food and Drug Administration-approved tobacco cessation medications, including both prescription and over-the-counter medications, that assist individuals to stop using tobacco products.

  (14) “Tobacco Use Prevention and Cessation Program” means the program created by Health-General Article, §§13-1001—13-1014, Annotated Code of Maryland, to provide tobacco use prevention and cessation services in Maryland.

  (15) “Underinsured” individual means an applicant:

    (a) Who has private medical insurance, Medical Assistance, Medicare, or Maryland Children’s Health Insurance Program coverage;

    (b) For whom the appropriate treatment is not adequately covered due to out-of-pocket costs including:

      (i) Copayments;

      (ii) Coinsurance; or

      (iii) Deductibles; and

    (c) Who the Department determines does not have the financial means to pay for appropriate treatment.

  (16) “Uninsured” individual means an applicant who:

    (a) Either:

      (i) Does not have private medical insurance, Medical Assistance, Medicare, or Maryland Children's Health Insurance Program coverage; or

      (ii) Has private medical insurance, Medical Assistance, Medicare, or Maryland Children's Health Insurance Program coverage that does not provide insurance coverage for medically necessary services for a cancer treatment service or tobacco treatment product; and

    (b) Does not have the financial means to pay for a cancer treatment service or tobacco treatment product as defined by the criteria established in this chapter.

  (17) “University of Maryland Medical Group (UMMG)” means the University of Maryland Medical Systems Corporation, the University of Maryland Medical School, and the University of Maryland, Baltimore.

#### Regulation .03 Responsibilities of the Department.

*COMAR 10.14.06.03*

The Department shall:

A. Establish guidelines for defining financial eligibility of an:

  (1) Uninsured or underinsured individual for the purpose of receiving cancer treatment services under the Cancer Prevention, Education, Screening and Treatment Program; and

  (2) Uninsured individual for the purpose of receiving tobacco treatment products under the Tobacco Use Prevention and Cessation Program; and

B. Review the written documentation submitted by a local health department or Statewide academic health center to assure that the criteria listed in Regulations .05 and .06 of this chapter are followed.

#### Regulation .04 Responsibilities of Local Health Departments and Statewide Academic Health Centers.

*COMAR 10.14.06.04*

A. If a local health department or a Statewide academic health center decides that grant funds under the Cigarette Restitution Fund Program will not be used to pay for cancer treatment services or tobacco treatment products:

  (1) This chapter does not apply; and

  (2) A local health department or a Statewide academic health center has no further responsibilities with respect to this chapter.

B. If a local health department or a Statewide academic health center decides that grant funds under the Cigarette Restitution Fund Program will be used to pay for cancer treatment services or tobacco treatment products:

  (1) This chapter applies; and

  (2) A local health department or a Statewide academic health center shall adhere to the financial guidelines established by the Department for:

    (a) Cancer treatment services as set forth in Regulation .05 of this chapter; and

    (b) Tobacco treatment products as set forth in Regulation .06 of this chapter.

#### Regulation .05 Criteria for Eligibility for Cancer Treatment Services.

*COMAR 10.14.06.05*

A. A local health department or a Statewide academic health center shall use the following financial eligibility criteria for cancer treatment services under the Cancer Prevention, Education, Screening and Treatment Program:

  (1) The basis for determining financial eligibility shall be the gross annual household income;

  (2) An applicant with a gross annual household income above 250 percent of the federal poverty level is not eligible to receive cancer treatment services;

  (3) Written documentation required for determination of the gross annual household income shall include:

    (a) The household’s most recent federal income tax return; or

    (b) If a household income tax return was not filed, the following:

      (i) The most recent W-2 statement;

      (ii) Pay stubs from two consecutive pays;

      (iii) A Social Security entitlement letter; or

      (iv) A notarized letter from the applicant stating that the applicant is not working and does not have any income;

  (4) The household income level for determining financial eligibility shall be based on the size of the family unit including the applicant and may include the following individuals as verified by the most recent tax return:

    (a) The applicant’s spouse;

    (b) Any financially dependent children; or

    (c) Any financially dependent relative; and

  (5) The type of written documentation that an applicant shall provide in order to document the size of the family unit includes the following:

    (a) The most recent income tax return;

    (b) A divorce decree, if applicable; or

    (c) If a household income tax return was not filed, written documentation shall include the names, ages, and relationship to the applicant of individuals supported by the gross annual household income.

B. A local health department or a Statewide academic health center may establish requirements for eligibility of cancer treatment services in addition to those cited in §A of this regulation.

#### Regulation .06 Criteria for Eligibility for Tobacco Treatment Products.

*COMAR 10.14.06.06*

A local health department shall make tobacco treatment products available free of charge to an individual participating in the Cigarette Restitution Fund Program.

#### Regulation .07 Funding Availability.

*COMAR 10.14.06.07*

Payment under this chapter is contingent on the availability of funds in accordance with State Finance and Procurement Article, §§7-234 and 7-235, Annotated Code of Maryland.