S T A T E O F N E W Y O R K
________________________________________________________________________
319
2021-2022 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 6, 2021
___________
Introduced by M. of A. CAHILL, WOERNER -- 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
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.
LBD01604-01-1
A. 319 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-TWO, IS LESS THAN OR EQUAL TO TWEN-
TY-FIVE THOUSAND DOLLARS. AFTER THE INITIAL DETERMINATION OF ELIGIBIL-
ITY, EACH ELIGIBLE INDIVIDUAL MUST BE REDETERMINED ELIGIBLE AT LEAST
EVERY TWENTY-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.
A. 319 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.