PRIOR PRINTER'S NO. 2179 PRINTER'S NO. 3665
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, COLAFELLA AND KASUNIC,
OCTOBER 1, 1985
AS REPORTED FROM COMMITTEE ON FINANCE, HOUSE OF REPRESENTATIVES,
AS AMENDED, JUNE 16, 1986
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. RECOMMENDATIONS. <--
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 "HEARING AID FITTING." AN AUDIOMETRIC FITTING CONDUCTED BY A <--
16 PHYSICIAN LICENSED TO PRACTICE MEDICINE AND SURGERY IN THIS
17 COMMONWEALTH; BY A HEARING AID FITTER REGISTERED UNDER THE ACT
18 OF NOVEMBER 24, 1976 (P.L.1182, NO.262), KNOWN AS THE HEARING
19 AID SALES REGISTRATION LAW; OR BY AN AUDIOLOGIST CERTIFIED BY
20 THE AMERICAN SPEECH AND HEARING ASSOCIATION.
21 "HEARING TEST." AN AUDIOMETRIC HEARING TEST CONDUCTED BY A
22 PHYSICIAN LICENSED TO PRACTICE MEDICINE AND SURGERY IN THIS
23 COMMONWEALTH OR BY AN AUDIOLOGIST CERTIFIED BY THE AMERICAN
24 SPEECH AND HEARING ASSOCIATION.
25 "Maximum annual income." A maximum figure of annual income
26 from any source to be used by the department to determine
27 claimant eligibility for the program. In the case of single
28 persons, the maximum annual income shall not exceed $7,500 when
29 the claimant makes a copayment of $5 for an examination or, <--
30 prescription OR RECOMMENDATION under the program and shall not <--
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1 exceed $12,000 when the claimant makes a $10 copayment. In the
2 case of married persons, the combined annual incomes shall not
3 exceed $10,500 when the claimant makes a $5 copayment and shall
4 not exceed $15,000 when the claimant makes a $10 copayment. The
5 maximum level of annual income shall be reviewed annually by the
6 department and adjusted to reflect any increases in the Consumer
7 Price Index.
8 "Prescribed device." Eyeglasses prescribed by a licensed
9 optometrist or ophthalmologist or hearing aids prescribed <--
10 RECOMMENDED by a licensed audiologist or doctor specializing in <--
11 treating the ear.
12 "Program." The program of optical-aural assistance to the
13 aged established by this act.
14 "Reasonable cost". The cost of prescribed devices or of eye
15 and ear examinations which will be funded by this act, as
16 determined by the department BY REGULATIONS PROMULGATED <--
17 ANNUALLY.
18 Section 3. Purpose.
19 This act hereby establishes a program in which moneys from
20 the State Lottery Fund can be withdrawn from the fund by the
21 department to reimburse eligible claimants in this program for
22 expenses they have incurred to receive eye examinations,
23 glaucoma tests, ear examinations, hearing tests, eyeglass
24 prescriptions and hearing aid prescriptions RECOMMENDATIONS. The <--
25 expenses shall have either been billed to the claimant or paid
26 by the claimant prior to the application for reimbursement.
27 Section 4. Initial application and annual renewal.
28 Application AN INDIVIDUAL WHO WISHES to participate in the <--
29 program shall be made MAKE AN APPLICATION to the department, <--
30 which shall process applications in accordance with this act and
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1 shall promulgate regulations to enforce this act. The department
2 shall send annual renewal notices to participants ELIGIBLE <--
3 CLAIMANTS.
4 Section 5. Payments under program.
5 The program shall consist of payment by the department for
6 the reasonable cost of eye examinations, glaucoma tests, ear
7 examinations, hearing test, eyeglass prescriptions and hearing
8 aid prescriptions. RECOMMENDATIONS. IN THE CASE OF HEARING AIDS, <--
9 THE DEPARTMENT SHALL ARRANGE WITH CARE-PROVIDERS FOR A RENTAL
10 AGREEMENT WHEREBY AN ELIGIBLE CLAIMANT RECEIVES A TRIAL HEARING
11 AID FOR 30 DAYS AND THE DEPARTMENT PAYS THE CARE-PROVIDER UP TO
12 $35; AT THE END OF THE 30 DAYS, THE ELIGIBLE CLAIMANT SHALL
13 DECIDE WHETHER THE HEARING AID SHOULD BE PURCHASED. At the
14 option of the eligible claimant, as indicated on the initial and
15 renewal application form, payments may be made:
16 (1) to the eligible claimant upon presentation by the
17 claimant to the department of a receipt or certified copy of
18 a receipt for the care provided; or
19 (2) directly to the care-provider upon presentation of a
20 bill by the care-provider to the department. The department
21 will deduct the amount of copayment to be made by the
22 claimant from the amount reimbursed by the department.
23 Reimbursement for eyeglasses and hearing aid prescriptions <--
24 EYEGLASS PRESCRIPTIONS AND HEARING AID RECOMMENDATIONS will <--
25 be made only if the prescribed device is American made.
26 Section 6. Notice of nonparticipation PARTICIPATION. <--
27 Any care-provider choosing not to participate in this program <--
28 shall post a conspicuous notice of nonparticipation <--
29 PARTICIPATION on its premises. <--
30 Section 7. Coordination of eligibility.
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1 Any otherwise eligible claimant whose eye and ear care is
2 wholly covered by any other plan of assistance or insurance
3 shall be ineligible for assistance under this act.
4 Section 8. Funding.
5 (a) Excess lottery moneys.--Funding for the program
6 established by this act shall be from any excess funds existing
7 in the State Lottery Fund after payment of all obligations
8 arising under the act of March 11, 1971 (P.L.104, No.3), known
9 as the Senior Citizens Rebate and Assistance Act, on an annual
10 basis.
11 (b) Appropriation.--The General Assembly may appropriate
12 General Fund moneys to fund in whole or in part the program
13 established by this act.
14 Section 9. Penalty for fraud.
15 (a) Care-provider fraud.--It is unlawful for any person to
16 defraud the Commonwealth by submitting to the department bills
17 purporting to charge for eye examinations, glaucoma tests, ear
18 examinations, hearing tests, eyeglasses or hearing aids for
19 eligible persons if such care was not provided to that person.
20 (b) Eligibility fraud.--It is unlawful for any person to
21 defraud the Commonwealth by misrepresenting to the department
22 facts pertaining to his eligibility to participate in the
23 program or by using evidence of his eligibility to obtain
24 reimbursement for care provided to another person not eligible
25 for the program.
26 (c) Penalty.--A person violating this section commits a
27 summary offense and shall, upon conviction, be sentenced to pay
28 a fine of $100 for each violation. Fines collected shall become
29 part of the General Fund and shall be designed for use in this
30 program.
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1 Section 10. Effective date.
2 This act shall take effect January 1, 1986 IN 90 DAYS. <--
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