S T A T E   O F   N E W   Y O R K
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                                  7159

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                             April 14, 2011
                               ___________

Introduced  by  M.  of  A. J. MILLER, BOYLE, CASTELLI, TEDISCO -- Multi-
  Sponsored by -- M. of A.  CAHILL, CROUCH, MAYERSOHN, SAYWARD  --  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:

  Section 1. Article 2 of the elder law is amended by adding a new title
5 to read as follows:
                                 TITLE 5
                        ELDERLY DENTAL INSURANCE
                            COVERAGE PROGRAM
SECTION 270. DEFINITIONS.
        271. ELDERLY DENTAL INSURANCE COVERAGE PROGRAM.
        272. PROGRAM ELIGIBILITY.
        273. REGULATIONS.
        274. PENALTIES FOR FRAUD AND ABUSE.
  S 270. DEFINITIONS. FOR PURPOSES OF THIS TITLE, THE TERMS:
  1. "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
SPOUSES AND SHALL EXCLUDE THE INCOME OF OTHER MEMBERS OF THE HOUSEHOLD.
  2. "RESIDENT" SHALL MEAN AN INDIVIDUAL LEGALLY  DOMICILED  WITHIN  THE
STATE.
  S  271.  ELDERLY DENTAL INSURANCE COVERAGE PROGRAM. THE DIRECTOR SHALL
ESTABLISH AN ELDERLY DENTAL INSURANCE COVERAGE PROGRAM, IN  CONSULTATION
WITH THE COMMISSIONER OF CIVIL SERVICE, WITHIN THE STATE EMPLOYEE DENTAL
INSURANCE  PLAN.    SUCH PROGRAM SHALL PROVIDE COMPREHENSIVE AND ROUTINE
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.
                                                           LBD08200-01-1
              

A. 7159                             2

ITY  REQUIREMENTS ESTABLISHED IN SECTION TWO HUNDRED SEVENTY-TWO OF THIS
TITLE. SUCH PROGRAM SHALL ONLY BE AVAILABLE IN DUTCHESS, KINGS,  SARATO-
GA,  SCHENECTADY, ULSTER, WARREN AND WASHINGTON COUNTIES UNTIL SUCH DATE
THAT THE DIRECTOR DETERMINES THAT EXPANDING SUCH PROGRAM SHALL BE APPRO-
PRIATE.
  S  272.  PROGRAM  ELIGIBILITY.  1. PERSONS ELIGIBLE FOR COVERAGE UNDER
SECTION TWO HUNDRED SEVENTY-ONE OF THIS TITLE SHALL INCLUDE:
  (A) ANY UNMARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF AGE AND
WHOSE INCOME FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING  THE  EFFECTIVE
DATE  OF  THIS  TITLE,  IS  LESS  THAN  OR  EQUAL TO TWENTY-TWO THOUSAND
DOLLARS. AFTER THE INITIAL DETERMINATION OF ELIGIBILITY,  EACH  ELIGIBLE
INDIVIDUAL  MUST  BE  REDETERMINED  ELIGIBLE  AT LEAST EVERY TWENTY-FOUR
MONTHS; AND
  (B) ANY MARRIED RESIDENT WHO IS AT LEAST SIXTY-FIVE YEARS OF  AGE  AND
WHOSE  INCOME  FOR THE CALENDAR YEAR IMMEDIATELY PRECEDING THE EFFECTIVE
DATE OF THE ANNUAL COVERAGE PERIOD WHEN COMBINED WITH THE INCOME IN  THE
SAME CALENDAR YEAR OF SUCH MARRIED PERSON'S SPOUSE BEGINNING ON OR AFTER
JANUARY FIRST, TWO THOUSAND ELEVEN, IS LESS THAN OR EQUAL TO TWENTY-FIVE
THOUSAND  DOLLARS.  AFTER THE INITIAL DETERMINATION OF ELIGIBILITY, EACH
ELIGIBLE INDIVIDUAL MUST BE REDETERMINED ELIGIBLE AT LEAST  EVERY  TWEN-
TY-FOUR MONTHS.
  2. ELIGIBILITY FOR ASSISTANCE UNDER THIS TITLE SHALL NOT BE GRANTED TO
ANY  PERSON  WHO  AT THE TIME AN APPLICATION IS MADE IS RECEIVING EQUIV-
ALENT OR BETTER COVERAGE FROM ANY OTHER PUBLIC OR  PRIVATE  THIRD  PARTY
PAYMENT  SOURCE OR INSURANCE PLAN THAN THOSE BENEFITS PROVIDED FOR UNDER
THIS TITLE.
  3. THE DIRECTOR SHALL ESTABLISH A SLIDING SCALE  SUCH  THAT  THE  MORE
INCOME  A  PERSON  ELIGIBLE FOR COVERAGE PURSUANT TO THIS TITLE HAS, THE
HIGHER SUCH PERSON'S PREMIUM AND  PROGRAM  COSTS  SHALL  BE.  THE  EXACT
AMOUNT OF PREMIUM EXPENSE PER ELIGIBLE PERSON SHALL BE DETERMINED BY THE
CURRENT  NEGOTIATED  PREMIUM  BETWEEN  THE  STATE AND THE STATE EMPLOYEE
DENTAL PLAN.
  S 273. REGULATIONS. PROGRAM REGULATIONS SHALL:
  1. PROVIDE FOR A PROCESS OF DETERMINING AND REDETERMINING  ELIGIBILITY
FOR PARTICIPATION IN THIS PROGRAM INCLUDING PROVISIONS FOR SUBMISSION OF
PROOF OF INCOME, AGE, AND RESIDENCY AND INFORMATION ON EXISTING COMPLETE
OR PARTIAL COVERAGE OF DENTAL EXPENSES UNDER A THIRD PARTY ASSISTANCE OR
INSURANCE PLAN;
  2.  PROVIDE FOR A FAIR HEARING PROCESS FOR INDIVIDUALS AND PARTICIPAT-
ING DENTISTS TO APPEAL DETERMINATIONS OR ACTIONS OF THE CONTRACTORS;
  3. ESTABLISH PROCEDURES FOR THE STATE TO RECOVER THE VALUE OF BENEFITS
OR PAYMENTS MADE UNDER THIS TITLE, IF ANY, THAT WERE BASED  ON  APPLICA-
TIONS  OR  CLAIMS SUBMITTED IN VIOLATION OF ANY PROVISION OF THIS TITLE;
AND
  4. ESTABLISH PROCEDURES TO ENSURE THAT  ALL  INFORMATION  OBTAINED  ON
PERSONS  PURSUANT  TO THIS TITLE SHALL REMAIN CONFIDENTIAL AND SHALL NOT
BE DISCLOSED TO PERSONS OR AGENCIES OTHER THAN THOSE  ENTITLED  TO  SUCH
INFORMATION BECAUSE SUCH DISCLOSURE IS NECESSARY FOR THE PROPER ADMINIS-
TRATION OF THE PROGRAM ESTABLISHED PURSUANT TO THIS TITLE.
  S  274.  PENALTIES  FOR  FRAUD  AND ABUSE. 1. ANY PERSON WHO KNOWINGLY
MAKES A FALSE STATEMENT OR REPRESENTATION, OR WHO BY DELIBERATE CONCEAL-
MENT OF ANY MATERIAL FACT,  OR  BY  IMPERSONATION  OR  OTHER  FRAUDULENT
DEVICE,  OBTAINS  OR  ATTEMPTS  TO OBTAIN OR AIDS OR ABETS ANY PERSON TO
OBTAIN ANY BENEFIT UNDER THIS TITLE TO WHICH HE OR SHE IS NOT  ENTITLED,
SHALL BE GUILTY OF A VIOLATION PUNISHABLE BY A FINE OF NOT MORE THAN TWO
HUNDRED FIFTY DOLLARS PER OCCURRENCE.

A. 7159                             3

  2.  ANY  PERSON  WHO,  HAVING  MADE APPLICATION TO RECEIVE ANY BENEFIT
UNDER THIS TITLE FOR THE USE AND BENEFIT OF ANOTHER AND HAVING  RECEIVED
IT, KNOWINGLY AND WILLFULLY CONVERTS SUCH BENEFIT OR ANY PART THEREOF TO
A  USE OTHER THAN FOR THE USE AND BENEFIT OF SUCH OTHER PERSON, SHALL BE
GUILTY  OF A VIOLATION PUNISHABLE BY A FINE OF NOT MORE THAN TWO HUNDRED
FIFTY DOLLARS PER OCCURRENCE.
  3. ANY PERSON WHO, WITH INTENT TO DEFRAUD, PRESENTS FOR  ALLOWANCE  OR
PAYMENT  ANY  FALSE  OR  FRAUDULENT  CLAIM  FOR  FURNISHING  SERVICES OR
MERCHANDISE, OR KNOWINGLY SUBMITS FALSE INFORMATION FOR THE  PURPOSE  OF
OBTAINING  GREATER  COMPENSATION THAN THAT TO WHICH HE OR SHE IS LEGALLY
ENTITLED FOR FURNISHING SERVICES OR MERCHANDISE,  OR  KNOWINGLY  SUBMITS
FALSE  INFORMATION  FOR  THE  PURPOSE  OF  OBTAINING  AUTHORIZATION  FOR
FURNISHING SERVICES OR MERCHANDISE UNDER THIS TITLE, SHALL BE GUILTY  OF
A CLASS A MISDEMEANOR.
  S   2.  The  sum  of  twenty  million  dollars  ($20,000,000),  or  so
much  thereof as may be necessary, is hereby appropriated to the depart-
ment of civil service out of any moneys in the  state  treasury  in  the
general  fund  to the credit of the local assistance account, not other-
wise appropriated, and made immediately available, for  the  purpose  of
carrying out the provisions of this act. Such moneys shall be payable on
the  audit  and  warrant  of  the  comptroller  on vouchers certified or
approved by the president of the department  of  civil  service  in  the
manner prescribed by law.
  S 3. This act shall take effect on the one hundred eightieth day after
it  shall have become a law. 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.