PRINTER'S NO. 2179
No. 1709 Session of 1985
INTRODUCED BY ITKIN, PETRONE, TRELLO, BOOK, WIGGINS,
D. R. WRIGHT, J. L. WRIGHT, STABACK, MAYERNIK, PISTELLA,
STEWART, NAHILL, CHADWICK, CALTAGIRONE, JOHNSON, DALEY,
KUKOVICH, COY, BLAUM, FISCHER, GEORGE, VROON, DeLUCA,
McVERRY, E. Z. TAYLOR, MRKONIC, BELFANTI, FOX, DISTLER,
PERZEL, HALUSKA, FLICK, PRESSMANN, WOGAN, HAGARTY, RYBAK,
DEAL, STEVENS, MICOZZIE, KOSINSKI, DAWIDA, OLASZ, GAMBLE,
FATTAH, ARTY, IRVIS, ANGSTADT, PRESTON, CIMINI, TELEK,
LEVDANSKY, MORRIS, J. TAYLOR, TRUMAN AND COLAFELLA,
OCTOBER 2, 1985
REFERRED TO COMMITTEE ON FINANCE, OCTOBER 2, 1985
AN ACT
1 Establishing a program providing for medical assistance to the
2 aged to pay for eye examinations, eyeglasses, hearing
3 examinations and hearing devices with lottery fund moneys.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Optical-Aural
8 Assistance to the Aged Act.
9 Section 2. Definitions.
10 The following words and phrases when used in this act shall
11 have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Copayment." The sum to be paid by eligible claimants for
14 ear and eye examinations, eyeglass prescriptions and hearing aid
1 prescriptions.
2 "Department." The Department of Aging of the Commonwealth.
3 "Eligible claimant." Any single or married resident of this
4 Commonwealth 65 years of age and over whose annual income is
5 less than the maximum annual income established by this act, or
6 any resident under 65 years of age who is dependent on a
7 resident over 65 years of age whose annual income is less than
8 the maximum annual income, if not otherwise qualified for
9 assistance under the act of June 13, 1967 (P.L.31, No.21), known
10 as the Public Welfare Code.
11 "Examination." An eye examination or glaucoma test conducted
12 by a licensed optometrist or ophthalmologist, or a hearing
13 examination conducted by a licensed audiologist or doctor
14 specializing in the ear.
15 "Maximum annual income." A maximum figure of annual income
16 from any source to be used by the department to determine
17 claimant eligibility for the program. In the case of single
18 persons, the maximum annual income shall not exceed $7,500 when
19 the claimant makes a copayment of $5 for an examination or
20 prescription under the program and shall not exceed $12,000 when
21 the claimant makes a $10 copayment. In the case of married
22 persons, the combined annual incomes shall not exceed $10,500
23 when the claimant makes a $5 copayment and shall not exceed
24 $15,000 when the claimant makes a $10 copayment. The maximum
25 level of annual income shall be reviewed annually by the
26 department and adjusted to reflect any increases in the Consumer
27 Price Index.
28 "Prescribed device." Eyeglasses prescribed by a licensed
29 optometrist or ophthalmologist or hearing aids prescribed by a
30 licensed audiologist or doctor specializing in treating the ear.
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1 "Program." The program of optical-aural assistance to the
2 aged established by this act.
3 "Reasonable cost". The cost of prescribed devices or of eye
4 and ear examinations which will be funded by this act, as
5 determined by the department.
6 Section 3. Purpose.
7 This act hereby establishes a program in which moneys from
8 the State Lottery Fund can be withdrawn from the fund by the
9 department to reimburse eligible claimants in this program for
10 expenses they have incurred to receive eye examinations,
11 glaucoma tests, ear examinations, hearing tests, eyeglass
12 prescriptions and hearing aid prescriptions. The expenses shall
13 have either been billed to the claimant or paid by the claimant
14 prior to the application for reimbursement.
15 Section 4. Initial application and annual renewal.
16 Application to participate in the program shall be made to
17 the department which shall process applications in accordance
18 with this act and shall promulgate regulations to enforce this
19 act. The department shall send annual renewal notices to
20 participants.
21 Section 5. Payments under program.
22 The program shall consist of payment by the department for
23 the reasonable cost of eye examinations, glaucoma tests, ear
24 examinations, hearing test, eyeglass prescriptions and hearing
25 aid prescriptions. At the option of the eligible claimant, as
26 indicated on the initial and renewal application form, payments
27 may be made:
28 (1) to the eligible claimant upon presentation by the
29 claimant to the department of a receipt or certified copy of
30 a receipt for the care provided; or
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1 (2) directly to the care-provider upon presentation of a
2 bill by the care-provider to the department. The department
3 will deduct the amount of copayment to be made by the
4 claimant from the amount reimbursed by the department.
5 Reimbursement for eyeglasses and hearing aid prescriptions
6 will be made only if the prescribed device is American made.
7 Section 6. Notice of nonparticipation.
8 Any care-provider choosing not to participate in this program
9 shall post a conspicuous notice of nonparticipation on its
10 premises.
11 Section 7. Coordination of eligibility.
12 Any otherwise eligible claimant whose eye and ear care is
13 wholly covered by any other plan of assistance or insurance
14 shall be ineligible for assistance under this act.
15 Section 8. Funding.
16 (a) Excess lottery moneys.--Funding for the program
17 established by this act shall be from any excess funds existing
18 in the State Lottery Fund after payment of all obligations
19 arising under the act of March 11, 1971 (P.L.104, No.3), known
20 as the Senior Citizens Rebate and Assistance Act, on an annual
21 basis.
22 (b) Appropriation.--The General Assembly may appropriate
23 General Fund moneys to fund in whole or in part the program
24 established by this act.
25 Section 9. Penalty for fraud.
26 (a) Care-provider fraud.--It is unlawful for any person to
27 defraud the Commonwealth by submitting to the department bills
28 purporting to charge for eye examinations, glaucoma tests, ear
29 examinations, hearing tests, eyeglasses or hearing aids for
30 eligible persons if such care was not provided to that person.
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1 (b) Eligibility fraud.--It is unlawful for any person to
2 defraud the Commonwealth by misrepresenting to the department
3 facts pertaining to his eligibility to participate in the
4 program or by using evidence of his eligibility to obtain
5 reimbursement for care provided to another person not eligible
6 for the program.
7 (c) Penalty.--A person violating this section commits a
8 summary offense and shall, upon conviction, be sentenced to pay
9 a fine of $100 for each violation. Fines collected shall become
10 part of the General Fund and shall be designed for use in this
11 program.
12 Section 10. Effective date.
13 This act shall take effect January 1, 1986.
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