|SAME AS||No Same As|
|Add Art 2 Title 5 §§270 - 274, Eld L|
|Establishes an elderly dental insurance coverage program.|
|05/11/2017||referred to aging|
|01/03/2018||referred to aging|
Go to top
NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A7743 SPONSOR: Cahill
TITLE OF BILL: An act to amend the elder law, in relation to establishing an elderly dental insurance coverage program; and making an appropriation therefor   PURPOSE OR GENERAL IDEA OF BILL: Directs the Commissioner of Civil Service to establish an Elderly Dental Insurance Coverage (EDIC) pilot program, within the state-employee dental insurance plan, that provides comprehensive and routine dental care services to qualified New York State senior residents.   SUMMARY OF SPECIFIC PROVISIONS: Section 1: Amends Article 2 of the Elder Law by adding new Title 5: Elderly Dental Insurance Coverage. Such program shall be established in the following counties: Dutchess, Kings, Saratoga, Schenectady, Ulster, Warren and Washington. Outlines program eligibility, regulations and penalties for fraud and abuse. Eligibility: Married and single New York State residents 65 and older, who are not currently covered under a private dental care plan or other government subsidized dental plan, are eligible for EDIC. Income levels for single residents may not exceed $22,000 per year and for married residents combined income may not exceed $25,000 per year. Establishes that the Director shall create a sliding scale such that the more income a person has, the higher such person's premium and program costs will be. Income: Income shall mean "household gross income" as defined in the real property tax circuit breaker credit program, pursuant to subparagraph (c) of paragraph one of subsection (e) of section six hundred six of the Tax Law, but only shall include the income of program applicants and spouse and shall exclude the income of other members of the household. Regulations: Provides for a fair hearing process, for individuals and participating dentists, to appeal determinations or actions of contractors. Establishes procedures to ensure that all information obtained on persons pursuant to the title remain confidential. Penalties for Fraud and Abuse: Makes falsification of information a violation punishable by a fine not to exceed $250. Makes intent to defraud the system on the part of a dentist a class A misdemeanor. Section 2: Appropriates $20 million to the Department of Civil Service out of the General Fund for the purposes of carrying out the provisions of this act.   JUSTIFICATION: According to Columbia University Medical Center "... For too many older Americans, oral health care is a luxury. Limited access to oral health- care poses one of the greatest crises for the health and well-being of America's elderly." After retirement dental insurance becomes an extra benefit most seniors cannot afford. Moreover, the Medicare system was not designed to cover routine dental care which often leaves seniors with only one option-not going to the dentist at all. Lack of routine dental care can cause significant health problems including gum disease, mouth cancers and loss of teeth, all of which can lead to greater health risks if not treated. The EDIC program is designed to help seniors gain access to much needed routine and comprehensive dental care. The program will be conducted as a pilot project at first but may be expanded to include additional counties as determined by the Director of Civil Service. By establishing an avenue for seniors to obtain much needed dental care now we can alleviate potential health risks in the future.   PRIOR LEGISLATIVE HISTORY: New Bill   FISCAL IMPLICATIONS: Makes an appropriation of $20 million to the Department of Civil Service out of the General Fund for the purposes of carrying out the provisions of this act.   EFFECTIVE DATE: This act shall take effect on the 180th day after it shall have become a law; provided, however, that effective immediately, the addition, amend- ment and/or repeal of any rule or regulation necessary for the implemen- tation of this act on its effective date is authorized and directed to be made and completed on or before such effective date.
Go to top
STATE OF NEW YORK ________________________________________________________________________ 7743 2017-2018 Regular Sessions IN ASSEMBLY May 11, 2017 ___________ Introduced by M. of A. CAHILL -- 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- 24 ity requirements established in section two hundred seventy-two of this EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD06383-01-7A. 7743 2 1 title. Such program shall only be available in Dutchess, Kings, Sarato- 2 ga, Schenectady, Ulster, Warren and Washington counties until such date 3 that the director determines that expanding such program shall be appro- 4 priate. 5 § 272. Program eligibility. 1. Persons eligible for coverage under 6 section two hundred seventy-one of this title shall include: 7 (a) any unmarried resident who is at least sixty-five years of age and 8 whose income for the calendar year immediately preceding the effective 9 date of this title, is less than or equal to twenty-two thousand 10 dollars. After the initial determination of eligibility, each eligible 11 individual must be redetermined eligible at least every twenty-four 12 months; and 13 (b) any married resident who is at least sixty-five years of age and 14 whose income for the calendar year immediately preceding the effective 15 date of the annual coverage period when combined with the income in the 16 same calendar year of such married person's spouse beginning on or after 17 January first, two thousand eighteen, is less than or equal to twenty- 18 five thousand dollars. After the initial determination of eligibility, 19 each eligible individual must be redetermined eligible at least every 20 twenty-four months. 21 2. Eligibility for assistance under this title shall not be granted to 22 any person who at the time an application is made is receiving equiv- 23 alent or better coverage from any other public or private third party 24 payment source or insurance plan than those benefits provided for under 25 this title. 26 3. The director shall establish a sliding scale such that the more 27 income a person eligible for coverage pursuant to this title has, the 28 higher such person's premium and program costs shall be. The exact 29 amount of premium expense per eligible person shall be determined by the 30 current negotiated premium between the state and the state employee 31 dental plan. 32 § 273. Regulations. Program regulations shall: 33 1. Provide for a process of determining and redetermining eligibility 34 for participation in this program including provisions for submission of 35 proof of income, age, and residency and information on existing complete 36 or partial coverage of dental expenses under a third party assistance or 37 insurance plan; 38 2. Provide for a fair hearing process for individuals and participat- 39 ing dentists to appeal determinations or actions of the contractors; 40 3. Establish procedures for the state to recover the value of benefits 41 or payments made under this title, if any, that were based on applica- 42 tions or claims submitted in violation of any provision of this title; 43 and 44 4. Establish procedures to ensure that all information obtained on 45 persons pursuant to this title shall remain confidential and shall not 46 be disclosed to persons or agencies other than those entitled to such 47 information because such disclosure is necessary for the proper adminis- 48 tration of the program established pursuant to this title. 49 § 274. Penalties for fraud and abuse. 1. Any person who knowingly 50 makes a false statement or representation, or who by deliberate conceal- 51 ment of any material fact, or by impersonation or other fraudulent 52 device, obtains or attempts to obtain or aids or abets any person to 53 obtain any benefit under this title to which he or she is not entitled, 54 shall be guilty of a violation punishable by a fine of not more than two 55 hundred fifty dollars per occurrence.A. 7743 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.