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

                                  1528

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            January 13, 2015
                               ___________

Introduced  by  Sens.  KLEIN, CARLUCCI, SAVINO -- read twice and ordered
  printed, and when printed to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to including  certain
  respiratory  diseases  and  obesity  within  disease management demon-
  stration programs (Part  A);  to  amend  the  public  health  law,  in
  relation  to  the reduction of emphysema, chronic bronchitis and other
  chronic respiratory diseases in children (Part B); to amend the public
  health law, in relation to directing the health research science board
  to study respiratory diseases and obesity (Part C); and to  amend  the
  public  health  law,  in  relation to breastfeeding of infants and the
  adolescent pregnancy nutrition counseling program (Part D)

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.   This act enacts into law major components of legislation
which combat the incidence of adult and child  obesity  and  respiratory
diseases.    Each component is wholly contained within a Part identified
as Parts A through D. The effective date for each  particular  provision
contained  within  such  Part  is  set forth in the last section of such
Part. Any provision in any section contained within  a  Part,  including
the effective date of the Part, which makes a reference to a section "of
this act", when used in connection with that particular component, shall
be  deemed to mean and refer to the corresponding section of the Part in
which it is found.  Section three of this act  sets  forth  the  general
effective date of this act.

                                 PART A

  Section  1.  Subdivisions 2 and 4 of section 2111 of the public health
law, as added by section 21 of part C of chapter 58 of the laws of 2004,
are amended to read as follows:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03952-01-5

              

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  2. The department shall establish the criteria  by  which  individuals
will  be  identified  as  eligible  for  enrollment in the demonstration
programs.  Persons eligible for enrollment  in  the  disease  management
demonstration  program  shall  be  limited  to  individuals who: receive
medical  assistance  pursuant  to  title  eleven  of article five of the
social services law and may be eligible for benefits pursuant  to  title
18 of the social security act (Medicare); are not enrolled in a Medicaid
managed  care  plan,  including  individuals who are not required or not
eligible to participate in Medicaid managed care  programs  pursuant  to
section three hundred sixty-four-j of the social services law; are diag-
nosed  with  chronic  health  problems as may be specified by the entity
undertaking the demonstration program, including, but not limited to one
or more of the following: congestive heart failure, chronic  obstructive
pulmonary  disease, asthma, EMPHYSEMA, CHRONIC BRONCHITIS, OTHER CHRONIC
RESPIRATORY DISEASES, diabetes, ADULT AND CHILDHOOD  OBESITY,  or  other
chronic health conditions as may be specified by the department; or have
experienced  or are likely to experience one or more hospitalizations or
are otherwise expected to incur excessive costs and high utilization  of
health care services.
  4.  The  demonstration program shall offer evidence-based services and
interventions designed to ensure that the enrollees receive high  quali-
ty, preventative and cost-effective care, aimed at reducing the necessi-
ty  for hospitalization or emergency room care or at reducing lengths of
stay when hospitalization is necessary. The  demonstration  program  may
include  screening  of  eligible enrollees, developing an individualized
care management plan for  each  enrollee  and  implementing  that  plan.
Disease management demonstration programs that utilize information tech-
nology  systems  that allow for continuous application of evidence-based
guidelines to medical assistance claims data and other available data to
identify specific instances in which clinical interventions  are  justi-
fied  and communicate indicated interventions to physicians, health care
providers and/or patients, and monitor physician and health care provid-
er response to such interventions, shall have the enrollees,  or  groups
of enrollees, approved by the department for participation. The services
provided  by  the  demonstration  program as part of the care management
plan may include, but are not limited to, case management, social  work,
individualized  health  counselors, multi-behavioral goals plans, claims
data management, health and self-care education, drug therapy management
and oversight, personal emergency response systems and other  monitoring
technologies,  SYSTEMATIC CHRONIC HEALTH CONDITIONS IDENTIFIED FOR MONI-
TORING, telehealth services and similar services designed to improve the
quality and cost-effectiveness of health care services.
  S 2. This act shall take effect immediately.

                                 PART B

  Section 1.  Section 2599-b of the public health  law,  as  amended  by
section  88  of  part B of chapter 58 of the laws of 2005, is amended to
read as follows:
  S 2599-b. Program development.  1. The program shall  be  designed  to
prevent  and  reduce the incidence and prevalence of obesity in children
and adolescents, especially among populations with high rates of obesity
and obesity-related health complications including, but not limited  to,
diabetes,  heart  disease,  cancer,  osteoarthritis,  asthma, EMPHYSEMA,
CHRONIC BRONCHITIS, OTHER CHRONIC RESPIRATORY DISEASES and other  condi-
tions.  The  program  shall  use recommendations and goals of the United

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States departments of agriculture and health  and  human  services,  the
surgeon general and centers for disease control AND PREVENTION in devel-
oping  and  implementing guidelines for nutrition education and physical
activity projects as part of obesity prevention efforts. The content and
implementation  of  the  program shall stress the benefits of choosing a
balanced, healthful diet from the many options available  to  consumers,
without  specifically  targeting  the elimination of any particular food
group, food product or food-related industry.
  2. The childhood obesity prevention program shall include, but not  be
limited to:
  (a)  developing  media health promotion campaigns targeted to children
and adolescents and their parents and caregivers that emphasize increas-
ing consumption of low-calorie, high-nutrient foods, decreasing consump-
tion of high-calorie, low-nutrient foods and increasing physical  activ-
ity designed to prevent or reduce obesity;
  (b)  establishing  school-based childhood obesity prevention nutrition
education and physical activity programs including programs described in
section twenty-five hundred ninety-nine-c of this article,  as  well  as
other  programs  with linkages to physical and health education courses,
and which utilize the school health index of  the  National  Center  for
Chronic  Disease  Prevention  and  Health  Promotion or other recognized
school health assessment PURSUANT TO ARTICLE NINETEEN OF  THE  EDUCATION
LAW;
  (c)  establishing  community-based childhood obesity prevention nutri-
tion education and physical activity programs including  programs  which
involve  parents  and caregivers, and which encourage communities, fami-
lies, child care and other settings to provide safe and  adequate  space
and  time for physical activity and encourage a healthy diet, AND CAN BE
IN COORDINATION WITH COUNTY COOPERATIVE EXTENSION  PROGRAMS  ESTABLISHED
PURSUANT TO SECTION TWO HUNDRED TWENTY-FOUR-B OF THE COUNTY LAW;
  (d)  coordinating  with  the state education department, department of
agriculture and markets, office of parks, recreation and historic  pres-
ervation, office of temporary and disability assistance, office of chil-
dren  and family services and other federal, state and local agencies to
incorporate strategies to prevent  and  reduce  childhood  obesity  into
government food assistance, health, education and recreation programs;
  (e)  sponsoring  periodic  conferences  or  meetings to bring together
experts in nutrition, exercise, public health, mental health, education,
parenting, media, food marketing, food security, agriculture,  community
planning  and  other  disciplines to examine societal-based solutions to
the problem of childhood obesity and issue  guidelines  and  recommenda-
tions for New York state policy and programs;
  (f)  developing training programs for medical and other health profes-
sionals to teach practical skills in nutrition and exercise education to
children and their parents and caregivers; [and]
  (g) developing screening programs in  coordination  with  health  care
providers and institutions including but not limited to day care centers
and  schools  for  overweight  and obesity for children aged two through
eighteen years, using body mass index  (BMI)  appropriate  for  age  and
gender,  and notification, in a manner protecting the confidentiality of
such children and their families, of parents of BMI status, and explana-
tion of the consequences of such status, including  recommended  actions
parents  may  need to take and information about resources and referrals
available to families to enhance  nutrition  and  physical  activity  to
reduce and prevent obesity[.]; AND

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  (H)  COORDINATING  WITH  THE EDUCATION DEPARTMENT, OFFICE OF TEMPORARY
AND DISABILITY ASSISTANCE, OFFICE OF CHILDREN AND  FAMILY  SERVICES  AND
OTHER  FEDERAL,  STATE  AND  LOCAL AGENCIES TO INCORPORATE STRATEGIES TO
CURTAIL THE INCIDENCE OF ASTHMA, CHRONIC BRONCHITIS  AND  OTHER  CHRONIC
RESPIRATORY  DISEASES  TO  ENABLE ADULTS AND CHILDREN TO SAFELY INCREASE
PHYSICAL ACTIVITY.
  3. The department, IN COOPERATION WITH THE EDUCATION DEPARTMENT, shall
periodically collect and analyze information from  schools,  health  and
nutrition  programs  and  other  sources  to determine the prevalence of
childhood obesity in New York state, and  to  evaluate,  to  the  extent
possible, the effectiveness of the childhood obesity prevention program.
  S 2. The opening paragraph of section 2599-c of the public health law,
as amended by section 88 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
  The  commissioner,  IN COOPERATION WITH THE COMMISSIONERS OF EDUCATION
AND AGRICULTURE AND MARKETS, AND COUNTY BOARDS OF COOPERATIVE EXTENSION,
shall encourage the  establishment  of  school-based  childhood  obesity
prevention and physical activity programs that promote:
  S 3. This act shall take effect immediately.

                                 PART C

  Section  1.    Paragraphs (a), (b) and (c) of subdivision 1 of section
2411 of the public health law, as amended by section  5  of  part  A  of
chapter 60 of the laws of 2014, are amended to read as follows:
  (a)  Survey  state  agencies, boards, programs and other state govern-
mental entities to assess what, if any, relevant data  has  been  or  is
being  collected  which  may  be of use to researchers engaged in breast
cancer research, OR ADULT AND CHILDHOOD OBESITY, ASTHMA,  CHRONIC  BRON-
CHITIS OR OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
  (b)  Consistent with the survey conducted pursuant to paragraph (a) of
this subdivision, compile a list of data  collected  by  state  agencies
which  may  be  of  assistance  to  researchers engaged in breast cancer
research as established in section twenty-four hundred  twelve  of  this
title,  AND  ADULT  AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR
OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
  (c) Consult with the Centers for Disease Control and  Prevention,  the
National Institutes of Health, the Federal Agency For Health Care Policy
and  Research,  the National Academy of Sciences and other organizations
or entities which may be involved in cancer  research  to  solicit  both
information regarding breast cancer research projects that are currently
being  conducted  and  recommendations for future research projects, AND
ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR OTHER CHRONIC
RESPIRATORY DISEASE RESEARCH PROJECTS;
  S 2. Subdivision 1 of section  2500  of  the  public  health  law,  as
amended  by  chapter  822  of  the  laws  of 1987, is amended to read as
follows:
  1. The commissioner shall act in an advisory and supervisory capacity,
in matters pertaining to the safeguarding of motherhood, the  prevention
of  maternal,  perinatal,  infant and child mortality, the prevention of
diseases, low birth weight, CHILDHOOD OBESITY, and defects of  childhood
and the promotion of maternal, prenatal and child health, including care
in  hospitals,  and shall administer such services bearing on the health
of mothers and children for which funds are or shall hereafter  be  made
available.
  S 3. This act shall take effect immediately.

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                                 PART D

  Section 1.  Section 2505-a of the public health law, as added by chap-
ter 292 of the laws of 2009, is amended to read as follows:
  S  2505-a.  Rights of breastfeeding mothers. 1. The principles enunci-
ated in subdivision three of this section are declared to be the  public
policy  of  the  state  and  a copy of such statement of rights shall be
posted conspicuously in a public place  in  each  maternal  health  care
facility  AND  CHILD  DAY CARE FACILITY.   For purposes of this section,
"maternal health care provider" means a  physician,  midwife,  or  other
authorized practitioner attending a pregnant woman; and "maternal health
care  facility"  includes  hospitals  and  freestanding birthing centers
providing perinatal services in accordance with article twenty-eight  of
this chapter and applicable regulations.
  2. The commissioner shall make available to every maternal health care
provider [and], maternal health care facility AND CHILD DAY CARE FACILI-
TY,  on  the  health department's website for the purpose of health care
facilities to include such rights in the maternity  information  leaflet
as  described in section twenty-eight hundred three-j of this chapter, a
copy of the statement of rights provided in subdivision  three  of  this
section  in the top six languages other than English spoken in the state
according to the latest available data from the U.S. Bureau  of  Census,
and  shall adopt any rules and regulations necessary to ensure that such
patients are treated in accordance with the provisions  of  such  state-
ment.
  3. The statement of rights shall consist of the following:
                 "Breastfeeding Mothers' Bill of Rights"
  Choosing  the  way you will feed your new baby is one of the important
decisions you will make in preparing for your infant's arrival.  Doctors
agree  that  for most women breastfeeding is the safest and most healthy
choice. It is your right to be informed about the  benefits  of  breast-
feeding  and  have your health care provider [and], maternal health care
facility AND CHILD DAY CARE FACILITY encourage and  support  breastfeed-
ing.  You  have  the  right to make your own choice about breastfeeding.
Whether you choose to breastfeed or not you  have  the  following  basic
rights  regardless  of  your race, creed, national origin, sexual orien-
tation, gender identity or expression, or source  of  payment  for  your
health  care.  Maternal  health care facilities have a responsibility to
ensure that you understand these rights. They must provide this informa-
tion clearly for you and must provide an interpreter if necessary. These
rights may only be limited in cases where your health or the  health  of
your  baby requires it. If any of the following things are not medically
right for you or your baby, you should be fully informed  of  the  facts
and be consulted.
(1)  Before  You  Deliver,  if  you attend prenatal childbirth education
classes provided by the maternal health care facility and  all  hospital
clinics and diagnostic and treatment centers providing prenatal services
in  accordance with article 28 of the public health law you must receive
the breastfeeding mothers' bill of rights.  Each  maternal  health  care
facility  shall provide the maternity information leaflet, including the
Breastfeeding Mothers' Bill of Rights, in accordance with section  twen-
ty-eight hundred three-i of [this chapter] THE PUBLIC HEALTH LAW to each
patient  or  to  the  appointed  personal  representative at the time of
prebooking or time of admission to a maternal health care facility. Each
maternal health care provider shall give a  copy  of  the  Breastfeeding

S. 1528                             6

Mothers'  Bill  of  Rights  to each patient at or prior to the medically
appropriate time.
  You  have  the  right  to  complete  information about the benefits of
breastfeeding for yourself and your baby. This will  help  you  make  an
informed choice on how to feed your baby.
  You  have  the right to receive information that is free of commercial
interests and includes:
  *  How  breastfeeding  benefits  you  and  your  baby   nutritionally,
medically and emotionally;
  * How to prepare yourself for breastfeeding;
  * How to understand some of the problems you may face and how to solve
them.
(2) In The Maternal Health Care Facility:
  * You have the right to have your baby stay with you right after birth
whether you deliver vaginally or by cesarean section. You have the right
to begin breastfeeding within one hour after birth.
  *  You  have  the right to have someone trained to help you in breast-
feeding give you information and help you when you need it.
  * You have the right to have your baby not receive any bottle  feeding
or pacifiers.
  *  You  have the right to know about and refuse any drugs that may dry
up your milk.
  * You have the right to have your baby in your room with you 24  hours
a day.
  * You have the right to breastfeed your baby at any time day or night.
  *  You  have the right to know if your doctor or your baby's pediatri-
cian is advising against breastfeeding before any feeding decisions  are
made.
  *  You have the right to have a sign on your baby's crib clearly stat-
ing that your baby is breastfeeding and that no bottle  feeding  of  any
type is to be offered.
  *  You  have  the  right to receive full information about how you are
doing with breastfeeding and get help on how to improve.
  * You have the right to breastfeed your baby in the neonatal intensive
care unit. If nursing is not possible, every attempt  will  be  made  to
have your baby receive your pumped or expressed milk.
  * If you, or your baby, are re-hospitalized in a maternal care facili-
ty  after the initial delivery stay, the hospital will make every effort
to continue to support breastfeeding, to provide hospital grade electric
pumps and rooming in facilities.
  * You have the right to have help from someone  specially  trained  in
breastfeeding  support  and  expressing  breast  milk  if  your baby has
special needs.
  * You have the right to have a family member or friend receive breast-
feeding information from a staff member if you request it.
(3) When You Leave The Maternal Health Care Facility:
  * You have the right to  printed  breastfeeding  information  free  of
commercial material.
  * You have the right, unless specifically requested by you, and avail-
able  at  the  facility,  to  be  discharged  from  the facility without
discharge packs containing infant formula,  or  formula  coupons  unless
ordered by your baby's health care provider.
  *  You have the right to get information about breastfeeding resources
in your community including information on availability of breastfeeding
consultants, support groups and breast pumps.

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  * You have the right to have the facility give you information to help
choose a medical provider for your baby and understand the importance of
a follow-up appointment.
  *  You  have  the right to receive information about safely collecting
and storing your breast milk.
  * You have the right to breastfeed your baby in any  location,  public
or  private, where you are otherwise authorized to be. Complaints can be
directed to the New York State Division of Human Rights.
  * YOU HAVE A RIGHT TO BREASTFEED YOUR BABY AT YOUR PLACE OF EMPLOYMENT
OR CHILD DAY CARE CENTER IN AN  ENVIRONMENT  THAT  DOES  NOT  DISCOURAGE
BREASTFEEDING OR THE PROVISION OF BREAST MILK.
  All  the  above  are your rights. If the maternal health care facility
does not honor these rights you can seek help by contacting the New York
state department of health  or  by  contacting  the  hospital  complaint
hotline or via email.
  4.  The  commissioner  shall  make regulations reasonably necessary to
implement this section.
  S 2. Section 2505 of the public health law, as added by chapter 479 of
the laws of 1980, is amended to read as follows:
  S 2505. Human  breast  milk;  collection,  storage  and  distribution;
general  powers  of  the  commissioner.    The  commissioner  is  hereby
empowered to:
  (a) adopt regulations and guidelines including,  but  not  limited  to
donor  standards,  methods of collection, and standards for storage, and
distribution of human breast milk;
  (b) conduct educational activities to inform  the  public  and  health
care  providers  of  the  availability  of human breast milk for infants
determined to require such milk and to inform potential  donors  of  the
opportunities for proper donation;
  (c) CONDUCT EDUCATIONAL ACTIVITIES TO ENCOURAGE AND FACILITATE EMPLOY-
ERS  AND  CHILD  DAY  CARE CENTERS TO ESTABLISH ENVIRONMENTS THAT DO NOT
DISCOURAGE BREASTFEEDING AND THE PROVISION OF BREAST MILK. SUCH ENVIRON-
MENTS MAY INCLUDE SANITARY LOCATIONS FOR BREASTFEEDING AND REFRIGERATORS
TO ASSIST IN BREASTFEEDING AND  FEEDING  BABIES  WITH  EXPRESSED  BREAST
MILK; AND
  (D)  establish  rules  and regulations to effectuate the provisions of
this section.
  S 3. Subdivision 2 of section 2515 of the public health law, as  added
by section 20 of part A of chapter 58 of the laws of 2008, is amended to
read as follows:
  2. "Services for eligible adolescents" means those services, including
but  not  limited  to: vocational and educational counseling, job skills
training, family life and parenting education, life skills  development,
coordination, case management, primary preventive health care, PREGNANCY
AND  CHILD  NUTRITION COUNSELING FOR EXPECTANT MOTHERS TO CURB THE INCI-
DENCE OF CHILDHOOD OBESITY, family  planning,  social  and  recreational
programs, child care, outreach and advocacy, follow-up on service utili-
zation, crisis intervention, and efforts to stimulate community interest
and involvement.
  S  4.  Paragraph  (c) of subdivision 2 of section 2515-a of the public
health law, as added by section 20 of part A of chapter 58 of  the  laws
of 2008, is amended to read as follows:
  (c)  serve  a geographic area where the incidence of infant mortality,
LOW BIRTH WEIGHT INFANTS, CHILDHOOD OBESITY and the prevalence  of  low-
income  families are high and where the availability or accessibility of
services for eligible adolescents is low;

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  S 5. Subdivision (b) of section 2522 of  the  public  health  law,  as
amended  by chapter 484 of the laws of 2009, is amended and a new subdi-
vision (e-1) is added to read as follows:
  (b) promotion of community awareness of the benefits TO THE MOTHER AND
CHILD of preconception health and early and continuous prenatal care;
  (E-1)  HEALTH AND NUTRITIONAL EDUCATION AND SERVICES FOR BOTH PARENTS,
REGARDING CHILDHOOD AND ADULT OBESITY AND ASTHMA, AND THE PREVENTION  OR
MITIGATION THEREOF;
  S 6. This act shall take effect immediately.
  S  2. Severability clause.  If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  3.  This  act shall take effect immediately provided, however, that
the applicable effective date of Parts A through D of this act shall  be
as specifically set forth in the last section of such Parts.