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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsApril 2014

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Copies of the proposed regulation are available for review in the April 1, 2014 edition of the Delaware Register of Regulations, accessible online at: http://regulations.delaware.gov or by calling the Comprehensive Cancer Control Program at 302-744-1032.
Email: Deborah.Harvey@state.de.us
1.1 The Cancer Treatment Program (CTP) is a program of Delaware Health and Social Services (DHSS), Division of Public Health (DPH) intended to provide medical insurance coverage to uninsured Delawareans for the treatment of cancer.
3.2 Each individual applying for the CTP is requested, but not required, to furnish his or her Social Security Number, if the individual has a Social Security Number.
4.1.4.1 Examples of health insurance include comprehensive, major medical and catastrophic plans, Veterans Affairs Medical Services, Correctional Healthcare Services, Medicare, and Medicaid.
4.1.57 Be over the age of 18 years.
4.1.68 Be diagnosed with any cancer on or after July 1, 2004, or be receiving benefits for the treatment diagnosis of colorectal cancer through the Division of Public Health’s Screening for Life program on June 30, 2004.
4.3 An inmate of a public institution shall be ineligible for the CTP, provided that the benefits of the CTP are not otherwise provided in full or in part.
5.3.5 Wages – net gross amount after before deductions for taxes and FICA
5.3.6 Senior Community Service Employment – net gross amount after before deductions for taxes and FICA
5.3.67 Interest/Dividends – gross amount
5.3.78 Capital Gains – gross amount from capital gains on stocks, mutual funds, bonds.
5.3.89 Credit Life or Credit Disability Insurance Payments – as paid
5.3.910 Alimony – as paid
5.3.1011 Rental Income from entire dwelling – gross rent paid minus standard deduction of 20% for expenses
5.3.1112 Roomer/Boarder Income – gross room/board paid minus standard deduction of 10% for expenses
5.3.1213 Self Employment – countable income as reported to Internal Revenue Service (IRS)
5.3.1314 Unemployment Compensation - as paid gross amount before deductions for taxes and FICA
5.5.2 Unmarried couples who live together as husband and wife a married couple.
5.5.3 Couples will be considered as living together as husband and wife a married couple if:
5.5.3.2 They are recognized as husband and wife a married couple in the community; or,
6.1 A Delaware resident is an individual who lives in Delaware with the intention to remain permanently or for an indefinite period, or where the individual is living and has entered into a job commitment, or seeking employment whether or not currently employed.
6.3.32 Will not be denied to an institutionalized individual because the individual did not establish residence in the community prior to admission to an institution.
6.3.43 Will not be terminated due to temporary absence from the State, if the person intends to return when the purpose of the absence has been accomplished.
7.1 The CTP may will verify information related to eligibility. Verification may be verbal or written and may be obtained from an independent or collateral source.
7.4 Failure to provide requested documentation may will result in denial or termination of eligibility.
8.1 The CTP will dispose of each application by a finding of full eligibility, temporary eligibility or ineligibility, unless:
910.0 Changes In Circumstances And Personal Information
910.1 Enrollees are responsible for notifying the CTP of all changes in his/her circumstances that could potentially affect eligibility for the CTP. Failure to do so may result in overpayments being processed and legal action taken to recover funds expended on his/her behalf during periods of ineligibility.
910.2 Enrollees are responsible for notifying the CTP of changes in the enrollee’s name, address and telephone number.
1011.0 Termination Of Eligibility
1011.1 Eligibility terminates:
1011.1.1 When the enrollee attains other medical insurance, including Medicare, Medicaid, and the Medicaid Breast and Cervical Cancer treatment program as listed in 4.1.4.
1011.1.2 When the enrollee is no longer receiving treatment for cancer as defined in 4.1.1.
1011.1.3 When the enrollee no longer meets the technical or financial eligibility requirements.
1011.1.45 Twenty-four months after the date that cancer treatment is initiated for each primary cancer diagnosis.
1011.2 If eligibility is terminated, it may only be renewed for an individual who is diagnosed with a new primary cancer. An individual who has a recurrence of cancer for which coverage has been previously provided is not eligible for additional coverage. The determination of a new primary cancer or recurring cancer is made by the treating physician.
1112.0 Coverage And Benefits
1112.1 Coverage is limited to the treatment of cancer as defined by DHSS.
1112.2 There is no managed care enrollment.
1112.3 Benefits will be paid at rates equivalent to Medicaid under a fee for service basis. If a Medicaid rate does not exist for the service provided, the CTP will determine a fair rate.
1112.4 Benefits will only be paid when the provider of the cancer treatment services is a Delaware Medicaid Assistance Provider.
1112.5 Benefits for patients enrolled prior to September 1, 2004 (or whatever date is established by DHSS as having an operational benefits management information system), may not be paid until after that date.
1112.6 The CTP is the payer of last resort and will only provide benefits to the extent that they are not otherwise covered by another insurance plan.
1112.7 Eligibility may be retroactive to the day that cancer treatment was initiated provided that the application is filed within one year of that day. In such circumstances, covered services will only be provided for the time period that the applicant is determined to have been eligible for the CTP.
1112.8 In no case will eligibility be retroactive to a time period prior to July 1, 2004, except if the enrollee was receiving benefits for the treatment of colorectal cancer through the Division of Public Health’s Screening for Life program on June 30, 2004. If this exception occurs, eligibility will be retroactive only to the date the enrollee was receiving benefits for colorectal cancer treatment through the Screening for Life program.
1213.0 Cancer Treatment Services Which Are Not Covered
1213.1 The cost of nursing home or long-term care institutionalization is not covered. (The cost of cancer treatment services within a nursing home or long term care institution is a covered benefit.)
1213.2 Services not related to the treatment of cancer as determined by DHSS are not covered.
1213.3 Cancer treatment services for which the enrollee is eligible to receive by other health plans as listed in 4.1.4.2 are not covered.
1314.0 Changes In Program Services
1314.1 When changes in program services require adjustments of CTP benefits, the CTP will notify enrollees who have provided an accurate and current name, and address or telephone number.
1415.0 Confidentiality
1415.1 The CTP will maintain the confidentiality of application, claim, and related records as required by law.
1516.0 Review Of CTP Decisions
1516.1 Any individual who is dissatisfied with a CTP decision may request a review of that decision.
1516.2 Such request must be received by the CTP in writing within 30 days of the date of the decision in question.
1516.3 The CTP will issue the results of its review in writing. The review will be final and not subject to further appeal.
Last Updated: December 31 1969 19:00:00.
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