Establishes an elderly dental insurance coverage program; establishes eligibility guidelines for such program; establishes penalties for fraud and abuse of the elderly dental insurance coverage program; appropriates $20,000,000 therefor.
STATE OF NEW YORK
________________________________________________________________________
7224
2009-2010 Regular Sessions
IN ASSEMBLY
March 26, 2009
___________
Introduced by M. of A. MILLER, TEDISCO, BOYLE -- Multi-Sponsored by --
M. of A. BACALLES, CAHILL, CROUCH, MAYERSOHN, SAYWARD, SCOZZAFAVA --
read once and referred to the Committee on Aging
AN ACT to amend the elder law, in relation to establishing an elderly
dental insurance coverage program; and making an appropriation there-
for
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Article 2 of the elder law is amended by adding a new title
2 5 to read as follows:
3 TITLE 5
4 ELDERLY DENTAL INSURANCE
5 COVERAGE PROGRAM
6 Section 270. Definitions.
7 271. Elderly dental insurance coverage program.
8 272. Program eligibility.
9 273. Regulations.
10 274. Penalties for fraud and abuse.
11 § 270. Definitions. For purposes of this title, the terms:
12 1. "Income" shall mean "household gross income" as defined in the real
13 property tax circuit breaker credit program, pursuant to subparagraph
14 (C) of paragraph one of subsection (e) of section six hundred six of the
15 tax law, but only shall include the income of program applicants and
16 spouses and shall exclude the income of other members of the household.
17 2. "Resident" shall mean an individual legally domiciled within the
18 state.
19 § 271. Elderly dental insurance coverage program. The director shall
20 establish an elderly dental insurance coverage program, in consultation
21 with the commissioner of civil service, within the state employee dental
22 insurance plan. Such program shall provide comprehensive and routine
23 dental care services to senior residents who meet the program eligibil-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09519-01-9
A. 7224 2
1 ity requirements established in section two hundred seventy-two of this
2 title. Such program shall only be available in Dutchess, Kings, Sarato-
3 ga, Schenectady, Ulster, Warren and Washington counties until such date
4 that the director determines that expanding such program shall be appro-
5 priate.
6 § 272. Program eligibility. 1. Persons eligible for coverage under
7 section two hundred seventy-one of this title shall include:
8 (a) any unmarried resident who is at least sixty-five years of age and
9 whose income for the calendar year immediately preceding the effective
10 date of this title, is less than or equal to twenty-two thousand
11 dollars. After the initial determination of eligibility, each eligible
12 individual must be redetermined eligible at least every twenty-four
13 months; and
14 (b) any married resident who is at least sixty-five years of age and
15 whose income for the calendar year immediately preceding the effective
16 date of the annual coverage period when combined with the income in the
17 same calendar year of such married person's spouse beginning on or after
18 January first, two thousand nine, is less than or equal to twenty-five
19 thousand dollars. After the initial determination of eligibility, each
20 eligible individual must be redetermined eligible at least every twen-
21 ty-four months.
22 2. Eligibility for assistance under this title shall not be granted to
23 any person who at the time an application is made is receiving equiv-
24 alent or better coverage from any other public or private third party
25 payment source or insurance plan than those benefits provided for under
26 this title.
27 3. The director shall establish a sliding scale such that the more
28 income a person eligible for coverage pursuant to this title has, the
29 higher such person's premium and program costs shall be. The exact
30 amount of premium expense per eligible person shall be determined by the
31 current negotiated premium between the state and the state employee
32 dental plan.
33 § 273. Regulations. Program regulations shall:
34 1. Provide for a process of determining and redetermining eligibility
35 for participation in this program including provisions for submission of
36 proof of income, age, and residency and information on existing complete
37 or partial coverage of dental expenses under a third party assistance or
38 insurance plan;
39 2. Provide for a fair hearing process for individuals and participat-
40 ing dentists to appeal determinations or actions of the contractors;
41 3. Establish procedures for the state to recover the value of benefits
42 or payments made under this title, if any, that were based on applica-
43 tions or claims submitted in violation of any provision of this title;
44 and
45 4. Establish procedures to ensure that all information obtained on
46 persons pursuant to this title shall remain confidential and shall not
47 be disclosed to persons or agencies other than those entitled to such
48 information because such disclosure is necessary for the proper adminis-
49 tration of the program established pursuant to this title.
50 § 274. Penalties for fraud and abuse. 1. Any person who knowingly
51 makes a false statement or representation, or who by deliberate conceal-
52 ment of any material fact, or by impersonation or other fraudulent
53 device, obtains or attempts to obtain or aids or abets any person to
54 obtain any benefit under this title to which he or she is not entitled,
55 shall be guilty of a violation punishable by a fine of not more than two
56 hundred fifty dollars per occurrence.
A. 7224 3
1 2. Any person who, having made application to receive any benefit
2 under this title for the use and benefit of another and having received
3 it, knowingly and willfully converts such benefit or any part thereof to
4 a use other than for the use and benefit of such other person, shall be
5 guilty of a violation punishable by a fine of not more than two hundred
6 fifty dollars per occurrence.
7 3. Any person who, with intent to defraud, presents for allowance or
8 payment any false or fraudulent claim for furnishing services or
9 merchandise, or knowingly submits false information for the purpose of
10 obtaining greater compensation than that to which he or she is legally
11 entitled for furnishing services or merchandise, or knowingly submits
12 false information for the purpose of obtaining authorization for
13 furnishing services or merchandise under this title, shall be guilty of
14 a class A misdemeanor.
15 § 2. The sum of twenty million dollars ($20,000,000), or so
16 much thereof as may be necessary, is hereby appropriated to the depart-
17 ment of civil service out of any moneys in the state treasury in the
18 general fund to the credit of the local assistance account, not other-
19 wise appropriated, and made immediately available, for the purpose of
20 carrying out the provisions of this act. Such moneys shall be payable on
21 the audit and warrant of the comptroller on vouchers certified or
22 approved by the president of the department of civil service in the
23 manner prescribed by law.
24 § 3. This act shall take effect on the one hundred eightieth day after
25 it shall have become a law. Effective immediately, the addition, amend-
26 ment and/or repeal of any rule or regulation necessary for the implemen-
27 tation of this act on its effective date is authorized and directed to
28 be made and completed on or before such effective date.
