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A07743 Summary:

BILL NOA07743
 
SAME ASNo Same As
 
SPONSORCahill
 
COSPNSRWoerner
 
MLTSPNSR
 
Add Art 2 Title 5 270 - 274, Eld L
 
Establishes an elderly dental insurance coverage program.
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A07743 Actions:

BILL NOA07743
 
05/11/2017referred to aging
01/03/2018referred to aging
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A07743 Memo:

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.
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A07743 Text:



 
                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.
                                                                   LBD06383-01-7

        A. 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.
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