Bill Text: NY A07224 | 2009-2010 | General Assembly | Introduced


Bill Title: 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.

Spectrum: Moderate Partisan Bill (Republican 8-2)

Status: (Introduced - Dead) 2010-01-06 - referred to aging [A07224 Detail]

Download: New_York-2009-A07224-Introduced.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         7224
                              2009-2010 Regular Sessions
                                 I N  A S S E M B L Y
                                    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    S 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    S  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    S  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    S 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    S 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    S   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    S 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.
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