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REGS : 10.14.05 Maryland Cancer Fund

 

 Content Editor

 
PROPOSAL
Maryland Register
Issue Date:  January 10, 2014
Volume 41 • Issue 1 • Pages 33—34
 
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 14 CANCER CONTROL
10.14.05 Maryland Cancer Fund
Authority: Health–General Article, §20–117, Annotated Code of Maryland
Notice of Proposed Action
[14-013-P]
                The Secretary of Health and Mental Hygiene proposes to amend Regulations .02, .08, .14, and .16 under COMAR 10.14.05 Maryland Cancer Fund.
Statement of Purpose
The purpose of this action is to revise and update the regulations to ensure that the Maryland Cancer Fund aligns with health reform changes, effective January 1, 2014. The proposed amendments will:
(1) Eliminate references to enrolling individuals in the Maryland Health Insurance Plan (MHIP);
(2) Amend references to reimbursing grantee MHIP costs; and
(3) Allow reimbursement to grantees for deductibles, co-pays, and co-insurance for individuals with any insurance.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele A. Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499; TTY:800-735-2258, or email to dhmh.reg@maryland.gov, or fax to 410-767-6483. Comments will be accepted through February 10, 2014. A public hearing has not been scheduled.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1)—(20) (text unchanged)
(21) “Federal poverty level” means [the amount of household income by family size that a family needs for basic necessities as determined by the federal] the poverty guidelines, as amended, which are updated [annually] periodically in the Federal Register by the U.S. Department of Health and Human Services and which are incorporated by reference by COMAR 10.11.03.01–1.
(22)—(33) (text unchanged)
(34) “Patient contribution amount” means the amount of money required by an individual’s health insurance policy to be paid by the individual for a given medical procedure or service received, excluding the deductible.
[(34)] (35)[(42)] (43) (text unchanged)
.08 Allowed Uses of the Funds.
A.—C. (text unchanged)
D. If a grantee is funded to conduct cancer secondary prevention or treatment, the grantee shall only provide clinical services to individuals who:
(1) Are Maryland residents; and
[(2) Are uninsured at the time of application for the grant and remain uninsured at the time of service delivery; and]
[(3)] (2) Have an annual family income that is not more than 250 percent of the federal poverty [level] guidelines.
E. If a grantee is funded to conduct cancer treatment, a grantee may use the grant funds [to either]:
(1) [Pay] For grants awarded before January 1, 2014 to provide MHIP reimbursement, to pay up to a maximum of $15,000 for direct costs per individual per year for the premium, deductible, coinsurance, and copay of the MHIP costs and for services not covered under MHIP [for individuals who;
(a) Meet the eligibility criteria in §D of this regulation; and
(b) Apply for and are accepted for MHIP coverage]; or
(2) To pay up to a specified amount, as determined by the Department, for direct costs per individual per year for the:
(a) Deductible and patient contribution amount for the reimbursed medical procedure or service for insured individuals; and
(b) Medical procedure or service not covered under their health insurance policy for individuals who meet the eligibility criteria of §D of this regulation; or
[(2)] (3) [Pay] To pay up to a maximum of $20,000 for direct costs per individual per year for the cancer treatment costs under the individual’s treatment plan:
(a)—(b) (text unchanged)
F. If a grantee is funded to pay for cancer treatment [under §E(1) of this regulation, the grantee]:
(1) [Shall] Under §E(1) of this regulation, the grantee shall only pay or direct the Department to pay MHIP the following for services directly related to the treatment of cancer for the individual diagnosed with cancer:
(a)—(c) (text unchanged)
(d) Copays; [and]
(2) Under §E(2) of this regulation, the grantee shall only pay or direct the Department to pay the deductible and patient contribution amount for the reimbursed medical procedure or service that the individual is required to pay for the services directly related to the diagnosis and treatment of cancer; and
[(2)] (3) May not pay any amount for the individual’s spouse, children, or other family members’ [enrolled in MHIP] health insurance costs.
G. For the purpose of §F(1) and (2) of this regulation, the Department shall pay the [MHIP fees] health insurance costs out of the funds that are set aside for the grantee.
H. (text unchanged)
.14 Application Process for Cancer Treatment Grants.
A.—C. (text unchanged)
D. An applicant seeking a cancer treatment grant to pay for [cancer treatment] deductibles and patient contribution costs through [the MHIP] their health insurance policy under Regulation [.08E(1)] .08E(2) of this chapter shall include in the Department’s application packet:
(1) [A copy of the completed MHIP enrollment application; and] A completed and signed Maryland Cancer Fund – Cancer Treatment Grant application that;
(a) Certifies that the applicant shall pay:
(i) The deductible and patient contribution amount; and
(ii) Costs for services not covered under the individual’s health insurance policy for a time period not to exceed 1 year; and
(b) Includes a treatment plan for a total request not to exceed a specified amount, as determined by the Department, per individual per year, including the:
(i) Deductible and patient contribution amount; and
(ii) Costs for services not covered under the individual’s health insurance policy.
(2) [A signed application that:
(a) Certifies that the applicant shall pay:
(i) The premium, deductible, coinsurance, and copay of the MHIP costs; and
(ii) For services not covered under MHIP for a time period not to exceed 1 year for the individual for whom the MHIP enrollment form is completed; and
(b) Includes a treatment plan for a total request not to exceed $15,000 per individual per year, including the:
(i) MHIP costs of the premium, deductible, coinsurance, and copay; and
(ii) Costs for services not covered under MHIP.] Documentation of the individual’s health insurance policy.
E. An applicant seeking a cancer treatment grant to pay directly for cancer treatment costs under Regulation [.08E(2)] .08E(3) of this chapter shall include in the Department’s application packet:
(1) A completed [non–MHIP] Maryland Cancer Fund – Cancer Treatment Grant application [form]; and
(2)—(3) (text unchanged)
.16 Payments, Terms, and Conditions of Grant Awards, and Terminations.
A.—B. (text unchanged)
C. Progress Reports.
(1)—(3) (text unchanged)
(4) A grantee receiving a cancer treatment grant shall include the following information in the comprehensive final report for each individual [for whom the grantee is paying MHIP premiums or for whom the grantee is] receiving funds for cancer treatment:
(a)—(g) (text unchanged)
(5) (text unchanged)
D.—I. (text unchanged)
JOSHUA M. SHARFSTEIN, M.D.
Secretary of Health and Mental Hygiene