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Active smoking occurs when a person directly inhales smoke from their own cigarette, while passive smoking, also known as environmental tobacco smoke (ETS), occurs when non-smokers inhale smoke from smokers (mainstream source) or from burning cigarettes, cigars, or pipes (side stream source)

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*Additional research is needed to examine long-term effects of newer smokeless tobacco products, such as dissolvables and U.S

Oral lesions associated with daily use of snus, a moist smokeless tobacco product

Rather than characterizing this proposal as a presumption, we are taking the view that when the patient's medical record includes a signed and dated written order or referral indicating the type of therapy needed, CMS (and our contractors) would treat the signature on the order or referral as equivalent to a signature on the plan of treatment