S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    553
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  Sen. TEDISCO -- read twice and ordered printed, and when
   printed to be committed to the Committee on Finance
 
 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
 4 to read as follows:
                                  TITLE 4
                         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.
   § 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.
   § 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.
                                                            LBD03103-01-9

 S. 553                              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.
   §  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 TWENTY, 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.
   § 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.
   §  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.

 S. 553                              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.
   §   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.
   § 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 are authorized and directed  to
 be made and completed on or before such effective date.