1. A. An applicant for a cancer treatment grant shall submit a completed application to the CCPC.
2. B. Cancer treatment grants are open and continuous throughout the year to the extent that funding is available.

3. C. An applicant seeking a cancer treatment grant to pay for cancer treatment costs shall include in the Department's application packet:

   1. (1) A completed cancer treatment grant application for each individual for whom grant funds are being requested, including the:

      1. (a) Name;
      2. (b) Phone number;
      3. (c) Mailing address;
      4. (d) County; and

      5. (e) Signature of the:

         1. (i) Individual diagnosed with cancer if the individual is an adult; or
         2. (ii) Parent or guardian if the individual diagnosed with cancer is younger than 18 years old;

   2. (2) A letter written by the individual’s physician on the physician’s letterhead:

      1. (a) Confirming:

         1. (i) That the individual has been diagnosed with or treated for cancer or the individual has a finding suggestive of cancer and needs to obtain a cancer diagnosis; and
         2. (ii) The dates of diagnosis or treatment; and

      2. (b) Containing the physician's:

         1. (i) Full name;
         2. (ii) Address;
         3. (iii) Specialty; and
         4. (iv) Medical license number;

   3. (3) Proof of current Maryland residency for at least 6 months before the application date for each individual for whom grant funds are being requested in one of the following forms:

      1. (a) Maryland driver’s license or State identification card;
      2. (b) Lease or rental agreement;
      3. (c) Property tax bill;
      4. (d) Motor vehicle registration;
      5. (e) Pay check or stub with name and home address;
      6. (f) Utility bill;
      7. (g) Voter registration card; or
      8. (h) W-2 statement issued not more than 12 months ago;

   4. (4) Proof of annual family income for each individual for whom grant funds are being requested, including a copy of at least one of the following:

      1. (a) Most recent:

         1. (i) Income tax return; or
         2. (ii) W-2 form;

      2. (b) Pay stubs for two:

         1. (i) Consecutive pays; or
         2. (ii) Pays in the same month;
      3. (c) Social security entitlement letter; or
      4. (d) Notarized letter from the individual stating that the individual is not working and does not have any income;

   5. (5) Documentation of the eligibility of the individual for grant funds, including:

      1. (a) The family size of the individual for whom the applicant is applying; and
      2. (b) The family’s annual household income;

   6. (6) Certification that the applicant will:

      1. (a) Keep financial records, as described in Regulation .16B of this chapter;
      2. (b) Send demographic and fiscal information on each individual covered to the CCPC at the end of the grant period; and
      3. (c) Act as the authorized representative of the individual.
   7. (7) Attestation that grant funds will not be used to supplant any existing funding for this cancer treatment activity; and

   8. (8) If the applicant currently receives funding for a similar cancer treatment activity, a list of the funding:

      1. (a) Source;
      2. (b) Amount; and
      3. (c) Period for the activity.

4. D. An applicant seeking a cancer treatment grant to pay for deductibles and patient contribution costs through their health insurance policy under Regulation .08E(2) of this chapter shall include in the Department’s application packet:

   1. (1) A completed and signed Maryland Cancer Fund — Cancer Treatment Grant application that;

      1. (a) Certifies that the applicant shall pay:

         1. (i) The deductible and patient contribution amount; and
         2. (ii) Costs for services not covered under the individual’s health insurance policy for a time period not to exceed 1 year; and

      2. (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:

         1. (i) Deductible and patient contribution amount; and
         2. (ii) Costs for services not covered under the individual’s health insurance policy.
   2. (2) Documentation of the individual’s health insurance policy.

5. E. An applicant seeking a cancer treatment grant to pay directly for cancer treatment costs under Regulation .08E(3) of this chapter shall include in the Department’s application packet:

   1. (1) A completed Maryland Cancer Fund — Cancer Treatment Grant application; and

   2. (2) A signed document that certifies that the applicant shall pay directly for cancer treatment costs for the individual for a time period not to exceed 1 year; and certifies that the applicant shall:

      1. (a) Reimburse the provider in an amount not greater than the Medical Assistance rate for the medical procedure or the HSCRC-regulated rate for the medical procedure performed, if the medical procedure is performed in a HSCRC-regulated facility; or
      2. (b) Accept the Medical Assistance rate as payment in full for the cancer treatment procedures performed, if the applicant is a medical provider; and

   3. (3) Includes a treatment plan for a total request not to exceed $20,000 per individual, including:

      1. (a) The planned cancer treatment procedures; and
      2. (b) The Medical Assistance or HSCRC-regulated rate for each procedure.

Authority: Health-General Article, §20-117; Tax-General Article, §2-112; Annotated Code of Maryland

Effective date:

Regulations .01 — .16 adopted as an emergency provision effective June 1, 2006 (33:15 Md. R. 1274); adopted permanently effective October 9, 2006 (33:20 Md. R. 1616)

Regulation .02B amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .02B amended as an emergency provision effective December 22, 2008 (36:2 Md. R. 97); amended permanently effective April 6, 2009 (36:7 Md. R. 524)

Regulation .02B amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .02B amended as an emergency provision effective January 1, 2014 (41:2 Md. R. 88); amended permanently effective May 12, 2014 (41:9 Md. R. 521)

Regulation .03A amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .05C amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .07 amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .08 amended effective October 4, 2010 (37:20 Md. R. 1393); March 18, 2013 (40:5 Md. R. 411)

Regulation .08 amended as an emergency provision effective January 1, 2014 (41:2 Md. R. 88); amended permanently effective May 12, 2014 (41:9 Md. R. 521)

Regulation .08D, E amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .09 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .10A amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .11 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .12 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .13 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .14 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .14C, D amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .14D, E amended as an emergency provision effective January 1, 2014 (41:2 Md. R. 88); amended permanently effective May 12, 2014 (41:9 Md. R. 521)

Regulation .15 amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .15B amended as an emergency provision effective June 12, 2008 (35:14 Md. R. 1243); amended permanently effective October 20, 2008 (35:21 Md. R. 1824)

Regulation .16C amended effective March 18, 2013 (40:5 Md. R. 411)

Regulation .16C amended as an emergency provision effective January 1, 2014 (41:2 Md. R. 88); amended permanently effective May 12, 2014 (41:9 Md. R. 521)

Regulation .16D amended effective October 4, 2010 (37:20 Md. R. 1393)