COMAR 10.14.06.02. Definitions

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

ounty 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

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.