Bill S2363-2013

Enacts comprehensive provisions to curtail the incidence of asthma and other respiratory diseases

Enacts comprehensive provisions to curtail the incidence of asthma and other respiratory diseases; requires teachers in public and non-public school systems to be trained in identifying and responding to asthma emergencies in accordance with standards to be prescribed by the commissioner of education in consultation with the commissioner of health; provides for a program of asthma disease management and control within the department of health; program shall provide various services to health care providers, patients, and others; authorizes the commissioner of health to make grants; provides for a study of asthma incidence and prevalence; provides for an annual report on the program; requires health care providers to provide pregnant women with information on in-utero exposure to tobacco smoke; requires residential leases to include information on the smoking restrictions for the leased premises and in common ares; prohibits idling of motor vehicle engines upon school grounds; authorizes school boards to allow certain students to use inhalers or nebulizers; requires the school that authorizes the use of an inhaler to prepare an asthma treatment plan for the student; ensures safety of all students who suffer from respiratory illnesses in New York; requires reporting of cases of asthma; provides for the curtailing of the use of chemicals which may trigger asthma episodes; provides for the use of the least toxic pesticides which effectively eradicate the targeted organism; includes certain respiratory diseases within the disease management demonstration program; provides for the reduction of emphysema, chronic bronchitis and other chronic respiratory diseases in children; relates to smoking restrictions in certain outdoor areas.

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  • Jan 8, 2014: REFERRED TO HEALTH
  • Jan 16, 2013: REFERRED TO HEALTH

Memo

BILL NUMBER:S2363

TITLE OF BILL: An act to amend the public health law, in relation to establishing the asthma prevention and education program (Part A); to amend the public health law, in relation to in-utero exposure to tobacco smoke prevention (Part B); to amend the public health law, in relation to reporting on the incidence of asthma (Part C); to amend the public health law, in relation to including certain respiratory diseases within disease management demonstration programs (Part D); to amend the public health law, in relation to the reduction of emphysema, chronic bronchitis and other chronic respiratory diseases in children (Part E); to amend the public health law, in relation to smoking restrictions in certain outdoor areas (Part F); to amend the education law, in relation to requiring all teachers to be trained in identifying and responding to asthma emergencies (Part G); to amend the real property law, in relation to residential rental property smoking policies (Part H); to amend the education law, in relation to requiring school districts and private elementary and secondary schools to establish and implement rules prohibiting the engine of any motor vehicle to remain idling while parked or standing on school grounds (Part I); to amend the education law, in relation to the use of inhalers and nebulizers (Part J); to amend the environmental conservation law, in relation to pesticide alternatives used at schools and day care centers (Part K); and to amend the public buildings law, in relation to curtailing the use of cleaning materials that induce or trigger asthma episodes (Part L)

PURPOSE: To establish a comprehensive statewide asthma management and control program which coordinates the efforts of individuals, families, health care providers, schools and community-based organizations to benefit the people of the State of New York at many levels.

SUMMARY OF PROVISIONS:

Section 1: Legislative Intent.

Section 2: (Part A) Adds a new Public Health Law Article 27-BB as follows:

Creates a new Public Health Law section 2725 to create an Asthma disease management and control program. The purpose of the program is to promote asthma disease management and education and outreach about asthma to people who suffer from asthma and their families, health care providers, and the general public.

Creates a new Public Health Law (PHL) section 2726 to require the Department of Health (DOH) to study the incidence and prevalence of asthma in New York state including current disease management practices. Such study shall include the cause and nature of the disease, behavioral and environmental triggers, an assessment of the need for patient-centered case management to meet specific physical and environmental needs of patients, outcome evaluations and an assessment of the ability of providers to systemically instruct and develop asthma management plans for patients and frequently review with patients and their families how to manage and control their

asthma. DOH shall also gather demographic information for monitoring the occurrence, frequency, incidence, cause, effect and severity of asthma. The gathered data can be used for research purposes and the Department of Health will develop a unique and confidential identifier to be used in the collection of patient information for the purposes described above. Information gathered pursuant to the Asthma incident reporting provisions of PHL Article 24-F can be used for the preparation of any reports contained in this Part A of this bill.

Creates a new PHL section § 2727 to require the Commissioner to submit an annual report, commencing January first, after the bill is enacted and continue annually thereafter. The report shall include the status and accomplishments of the program and provide recommendations to the governor, the temporary president and the minority leader of the senate, and the speaker and the minority leader of the assembly.

Section 3: (Part B) Adds a new Article 13-I to the Public Health Law to establish a program to prevent in-utero exposure to tobacco smoke. Under this program, health care providers, health insurers, and pregnancy programs shall distribute information on the adverse effects of smoking during pregnancy, both first hand and second hand smoke. In-utero exposure to tobacco smoke leads to lower birth rates, higher incidences of asthma and childhood obesity, and can lead to cognitive and developmental damage to the child. Under this article, individualized smoking cessation programs would be established to increase the success rates for mothers who smoke tobacco or live in households where others smoke tobacco. This program will help to reduce the incidence of asthma.

Section 4: (Part C) Adds a new Public Health Law Article 24-F to establish an Asthma Incidence Reporting program that is similar to one that already exists to map the incidence of cancer in New York. The bill defines asthma attacks as a reportable disease that physicians, other health care providers, hospitals, and other health care facilities are required to report to the Health Department

(DOH). The Department shall establish what constitutes a reportable event, so that information received by DOH can be used to track where and who is affected by asthma attacks. Among the demographic information to be collected and sorted for those afflicted with asthma includes by age, residence, location, proximity to industrial and transportation sites, race, and by school.

Section 5: (Part D) Amends Public Health Law section 2111 to expand the scope of disease management demonstration programs administered by DOH to enhance the quality and cost-effectiveness of care rendered to Medicaid-eligible persons who do not participate in Medicaid Managed Care who have chronic health problems. Under current law, demonstration programs can include chronic conditions related to congestive heart failure, chronic obstructive pulmonary disease, asthma and diabetes. This provision expands the scope of demonstration programs to include chronic conditions related to emphysema, chronic bronchitis, and other respiratory diseases.

Section 6: (Part E) Amends Public Health Law section 2599-b to expand the scope of programs administered by DOH to reduce the incidence and prevalence of obesity in children and adolescents, especially among

populations with high rates of obesity. Under current law, the program looks to address obesity related health complications such as diabetes, heart disease, cancer, osteoarthritis, and asthma. This bill would expand such programs to include obesity-related health complications such as emphysema, chronic bronchitis, and other chronic respiratory diseases.

Section 7: (Part F) Adds a new Public Health Law section 1399-0-1 to expand the provisions of the law that regulates smoking in certain indoor areas open to the public to also include certain outdoor areas open to the public. Under this provision, it is prohibited to smoke within 15 feet from the entrance or exit of public buildings or private buildings that contain state or municipal offices or educational facilities. The underlying purpose of this provision is to ensure that a person who needs to conduct public business or students who enter into elementary and secondary schools, that are located in private buildings, are not exposed to second-hand tobacco smoke that may trigger an asthma episode or attack.

Section 8: (Part G) Adds a new Education Law section 3001-e to require the Education Commissioner, in consultation with the Commissioner of Health, to establish standards for the training of teachers and other appropriate personnel in identifying and responding to asthma emergencies.

Section 9: (Part H) Adds Real Property Law section 235-h to require that every rental agreement for an apartment in a building that has four units or more must disclose the smoking policy of such building, The landlord is still free to either fully ban, partially ban, or generally permit smoking in such building's apartments and common areas. It is the purpose of this section to encourage landlords to think about the building's smoking policy and to give tenants notice of such policies. This in turn may encourage non-smoker tenants to seek out apartment buildings that have a no smoking policy and encourage landlords to at least minimize smoke exposure to those tenants who do not smoke to increase the marketability of their apartments.While this bill is a comprehensive bill to address asthma issues, there is a correlation between those who are exposed, either voluntary or otherwise, to first and second hand tobacco smoke, and asthma. It would be difficult to address asthma issues without looking at the incidence of tobacco smoking and exposing, particularly children, to such conditions that can trigger asthma attacks and increase the incidence of asthma conditions generally.

Section 10: (Part I) Adds a new Education Law section 1527-a to expand the concept and provisions contained in Chapter 670 of the Laws of 2007 which mandated that the Department of Education promulgate rules and regulations to minimize the discharge of school bus exhaust on school grounds when such vehicles were loading and unloading students. The underlying purpose of this law was to minimize diesel exhaust from idling school busses to help lower the incidence of asthma and reduce the number of asthma attacks sustained by school children. This bill proposes to expand the prohibition on idling school busses to include all other private vehicles that deliver or discharge students on school grounds. While many students are transported to and from school by school busses, many others are transported by family members individually to school. The standard operating procedure for most

schools is that a separate line of cars is established and the students must remain in those private vehicles until a designated time, at which time the students are discharged or picked up. During the wait time, many private vehicles continue to operate and discharge emissions which can lead to an increased incidence of asthma conditions or a full fledged asthma attack. This provision encourages such private vehicles to turn off their engines to reduce the amount of emissions and triggers for asthma attacks.

Section 11: (Part J) Amends Education Law section 916 to expand the number of students who can have and use an inhaler at school to maintain appropriate airflow to their lungs or suppress an asthmatic attack.The medical community maintains that it is better to monitor and address those who are susceptible to asthma conditions and treat such conditions before an asthmatic attack occurs, This bill increases the number of persons who can have and use an inhaler at school to include not only those who have a 'severe asthmatic condition", to also include those who have a "moderately severe asthmatic condition" or have other potentially life-threatening respiratory illnesses".

Section 2 of this Part J also adds a new Education Law section 921 to authorize school districts to posses and use nebulizers for those students that need such treatments. As the number and severity asthma attacks increases in the student body, it is important that such students have access not only to their inhalers, but nebulizers as well.The bill provides safeguards to ensure that only students that have a physician's treatment plan can use such nebulizers on school grounds.Further, such nebulizer treatment must be monitored by the school nurse or other person authorized by regulation.

Section 12: (Part K) Amends Environmental Conservation Law section 33-0303 (7) to expand the scope of this section of law which empowers the Commissioner of Environmental Conservation (DEC) to promulgate rules and guidance on the use pesticide alternatives to minimize pesticide applications in day care centers and in schools. This proposed provision allows DEC to identify pesticide alternatives that can help to minimize the incidence of asthma attacks in public buildings and homes, while still effectively controlling the targeted pest or organization. Studies have shown that higher levels of cockroach and mouse allergens can increase the incidence of asthma episodes or attacks.To control these conditions, the heightened use of pesticides is generally required to keep such pests under control. However, the application of pesticides also, can increase the incidence of asthma episodes or attacks.Hence, lower levels of pesticide applications are a desired to minimize asthma conditions. This provision asks DEC, in consultation with DOH, to advise those who apply pesticides in homes and public buildings to use pesticides that can help to minimize targeted pests, but also which does not, as best as possible, heighten the incidence of asthma conditions or attacks. It is important to embody in the law the conflicting goals of pesticide use, while still considering its effect asthma conditions.

Section 13: (Part L) Adds a new Public Buildings Law section 143 to curtail the use of cleaning materials or chemicals that can induce or trigger asthma attacks. The superintendent of every state public building and every public transportation facility operated by a public authority, public benefit corporation or municipality shall curtail,

to the best of their ability, the use of cleaning materials or chemicals that may cause their the building's cleaning staff or the general public to have an asthma attack or increase the incidence of such an asthma condition. In determining which cleaning products and concentration of cleaning chemicals that may trigger an asthma attack or increase the incidence of an asthmatic condition for cleaning staff or the general public, DOH shall promulgate a list of such chemicals to guide the actions of building superintendents.

JUSTIFICATION: Asthma is a chronic, potentially life-threatening, respiratory illness that affects over a million New Yorkers, including many who are children and adolescents. Asthma is also directly linked to large and growing inpatient and outpatient bills paid for by Medicaid and other health care payers, which in most cases could be avoided through early education and treatment of this condition. Asthma is the most common chronic disorder in children and adolescents and is responsible for approximately 10 million missed school days each year which is three times the amount for children without this debilitating ailment. In recent years, asthma has become the leading cause of hospitalization among children in New York and since 1980, the death rate among sufferers has increased a staggering 50%. In one area of the Bronx known as ".Asthma Alley" the rate of asthma sufferers is 7 1/2 times that of the national average.

Research and preventive efforts need to be increased. This is because numerous studies show that early education, screening, and treatment is a very cost effective method to address this growing public health problem. Establishing a comprehensive statewide asthma management program which coordinates the efforts of individuals, families, health care providers, schools and community-based organizations would help New York track the disease, better understand its causes and triggers, and direct asthma education and preventive care to the children and families who need it the most.

LEGISLATIVE HISTORY: 2012- S. 5863 - Referred to Health

FISCAL IMPLICATIONS: Some of the provisions of this bill may be subject to fiscal appropriation.

EFFECTIVE DATE: See the individual effective dates for each Part of this bill.


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STATE OF NEW YORK ________________________________________________________________________ 2363 2013-2014 Regular Sessions IN SENATE January 16, 2013 ___________
Introduced by Sens. KLEIN, CARLUCCI, GRISANTI, 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 establishing the asthma prevention and education program (Part A); to amend the public health law, in relation to in-utero exposure to tobacco smoke prevention (Part B); to amend the public health law, in relation to reporting on the incidence of asthma (Part C); to amend the public health law, in relation to including certain respiratory diseases within disease management demonstration programs (Part D); to amend the public health law, in relation to the reduction of emphysema, chronic bronchitis and other chronic respiratory diseases in children (Part E); to amend the public health law, in relation to smoking restrictions in certain outdoor areas (Part F); to amend the education law, in relation to requiring all teachers to be trained in identify- ing and responding to asthma emergencies (Part G); to amend the real property law, in relation to residential rental property smoking poli- cies (Part H); to amend the education law, in relation to requiring school districts and private elementary and secondary schools to establish and implement rules prohibiting the engine of any motor vehicle to remain idling while parked or standing on school grounds (Part I); to amend the education law, in relation to the use of inhal- ers and nebulizers (Part J); to amend the environmental conservation law, in relation to pesticide alternatives used at schools and day care centers (Part K); and to amend the public buildings law, in relation to curtailing the use of cleaning materials that induce or trigger asthma episodes (Part L) 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 asthma and other respiratory diseases such as emphysema and chronic bronchitis. Each component is wholly contained within a Part identified as Parts A through L. 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 refer- ence to a section "of this act", when used in connection with that particular component, shall be deemed to mean and refer to the corre- sponding section of the Part in which it is found. Section four of this act sets forth the general effective date of this act. S 2. Legislative findings and purpose. The legislature finds that asthma is a chronic, potentially life-threatening, respiratory illness that affects over a million New Yorkers, including thousands of children and adolescents. Asthma is the leading cause of school absences attri- buted to chronic conditions. Asthma is also directly linked to large and growing inpatient bills for medicaid and other health care payers. Therefore, the legislature finds that establishing a comprehensive statewide asthma prevention management and control program which coordi- nates the efforts of individuals, families, health care providers, schools and community-based organizations is in the public interest and would benefit the people of the state of New York. PART A Section 1. The public health law is amended by adding a new article 27-BB to read as follows: ARTICLE 27-BB ASTHMA DISEASE MANAGEMENT AND CONTROL SECTION 2725. ASTHMA DISEASE MANAGEMENT AND CONTROL PROGRAM. 2726. STUDY OF ASTHMA INCIDENCE AND PREVALENCE. 2727. ANNUAL REPORT. S 2725. ASTHMA DISEASE MANAGEMENT AND CONTROL PROGRAM. 1. THERE IS HEREBY CREATED WITHIN THE DEPARTMENT THE ASTHMA DISEASE MANAGEMENT AND CONTROL PROGRAM (HEREINAFTER REFERRED TO IN THIS ARTICLE AS THE "PROGRAM"). THE PURPOSE OF THE PROGRAM IS TO PROMOTE ASTHMA DISEASE MANAGEMENT AND EDUCATION AND OUTREACH ABOUT ASTHMA TO PEOPLE WHO SUFFER FROM ASTHMA AND THEIR FAMILIES, HEALTH CARE PROVIDERS, AND THE GENERAL PUBLIC. 2. SERVICES TO BE PROVIDED BY THE PROGRAM MAY INCLUDE: (A) ASTHMA DISEASE MANAGEMENT AND CASE MANAGEMENT FOR PATIENTS AND THEIR FAMILIES; (B) ASTHMA OUTREACH AND SCREENING; (C) THE PROMOTION OF AWARENESS OF THE CAUSES OF ASTHMA; (D) EDUCATION ON PREVENTION STRATEGIES; (E) EDUCATION ON PROPER DISEASE MANAGEMENT PRACTICES; AND (F) EDUCATION ON AVAILABLE TREATMENT MODALITIES. 3. THE COMMISSIONER SHALL MAKE GRANTS WITHIN THE AMOUNTS APPROPRIATED THEREFOR TO LOCAL HEALTH AGENCIES, HEALTH CARE PROVIDERS, SCHOOLS, SCHOOL BASED HEALTH CENTERS AND COMMUNITY-BASED ORGANIZATIONS, AND OTHER ORGANIZATIONS WITH DEMONSTRATED INTEREST AND EXPERTISE IN SERVING PERSONS WITH ASTHMA TO PROVIDE THE SERVICES SET OUT IN THIS SECTION. GRANT RECIPIENTS SHALL BE GOVERNMENT ENTITIES OR NOT-FOR-PROFIT ORGAN- IZATIONS. THE COMMISSIONER MAY COORDINATE GRANTS UNDER THIS SUBDIVISION WITH THE AVAILABILITY OF GRANTS FROM OTHER SOURCES. THE COMMISSIONER MAY ALSO ACCEPT OR SEEK GRANTS FROM OTHER SOURCES TO ENHANCE THE AMOUNTS APPRO- PRIATED TO THE PROGRAM. S 2726. STUDY OF ASTHMA INCIDENCE AND PREVALENCE. 1. THE DEPARTMENT SHALL STUDY THE INCIDENCE AND PREVALENCE OF ASTHMA IN THE STATE'S POPU- LATION AND CURRENT DISEASE MANAGEMENT PRACTICES. SUCH STUDY SHALL
UTILIZE INFORMATION OBTAINED PURSUANT TO ARTICLE TWENTY-FOUR-F OF THIS CHAPTER, AND INCLUDE: (A) THE CAUSE AND NATURE OF THE DISEASE; (B) BEHAVIORAL AND ENVIRONMENTAL TRIGGERS; (C) AN ASSESSMENT OF THE NEED FOR PATIENT-CENTERED CASE MANAGEMENT TO MEET SPECIFIC PHYSICAL AND ENVIRONMENTAL NEEDS OF PATIENTS; (D) OUTCOME EVALUATIONS, INCLUDING, BUT NOT LIMITED TO, PATIENT PERCEPTIONS OF IMPROVEMENT, SIGNS AND SYMPTOMS OF ASTHMA, PULMONARY FUNCTION, HISTORY OF ASTHMA EXACERBATIONS, PHARMACOTHERAPY, ASSESSMENT OF HOSPITAL EMERGENCY ROOM VISITS FOR ASTHMA, AND PATIENT-PROVIDER COMMUNICATION; AND (E) AN ASSESSMENT OF THE ABILITY OF PROVIDERS, INCLUDING NON-PROFES- SIONALS AND HEALTH CARE PROFESSIONALS SUCH AS PHYSICIANS, NURSES, PHAR- MACISTS AND RESPIRATORY THERAPISTS, TO SYSTEMICALLY INSTRUCT AND DEVELOP ASTHMA MANAGEMENT PLANS FOR PATIENTS AND FREQUENTLY REVIEW WITH PATIENTS AND THEIR FAMILIES HOW TO MANAGE AND CONTROL THEIR ASTHMA. 2. THE DEPARTMENT SHALL GATHER DATA FOR MONITORING THE OCCURRENCE, FREQUENCY, INCIDENCE, CAUSE, EFFECT AND SEVERITY OF ASTHMA. (A) THE DEPARTMENT MAY REQUIRE THE FOLLOWING TO REPORT DATA UNDER THIS SUBDIVISION: I. THE STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM (SPARCS); II. HEALTH MAINTENANCE ORGANIZATIONS LICENSED PURSUANT TO ARTICLE FORTY-THREE OF THE INSURANCE LAW OR CERTIFIED PURSUANT TO THIS CHAPTER OR AN INDEPENDENT PRACTICE ASSOCIATION CERTIFIED OR RECOGNIZED PURSUANT TO THIS CHAPTER; III. OTHER INSURERS; IV. THE MEDICAID (TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT) PROGRAM; V. HEALTH FACILITIES; VI. HEALTH CARE PRACTITIONERS; VII. PATIENTS: SELF REPORTING; VIII. THE DEPARTMENT OF ENVIRONMENTAL CONSERVATION; AND IX. ANY OTHER SOURCE THE COMMISSIONER DEEMS APPROPRIATE. (B) THE DEPARTMENT SHALL COMPILE AND ANALYZE DATA GATHERED UNDER PARA- GRAPH (A) OF THIS SUBDIVISION AND ARTICLE TWENTY-FOUR-F OF THIS CHAPTER, AND CORRELATE IT WITH DATA AS TO PLACES OF EMPLOYMENT, AREAS OF RESI- DENCE, SCHOOLS ATTENDED, AGES OF THOSE AFFLICTED, ENVIRONMENTAL FACTORS INCLUDING PROXIMITY TO SOURCE OF POLLUTION AND SUCH OTHER DATA AS THE DEPARTMENT DEEMS APPROPRIATE. (C) THE DEPARTMENT SHALL MAINTAIN AND COMPILE REPORTED DATA IN A MANNER SUITABLE FOR RESEARCH PURPOSES AND SHALL COLLECT AND MAKE SUCH DATA AVAILABLE TO PERSONS IN THE MANNER SET FORTH IN SUBDIVISION THREE OF THIS SECTION. 3. ANY DATA COLLECTED OR REPORTED SHALL NOT CONTAIN THE NAME OF ANY PATIENT, HIS OR HER SOCIAL SECURITY NUMBER, OR ANY OTHER INFORMATION WHICH WOULD PERMIT A PATIENT TO BE IDENTIFIED. THE DEPARTMENT SHALL DEVELOP A UNIQUE, CONFIDENTIAL IDENTIFIER TO BE USED IN THE COLLECTION OF PATIENT INFORMATION AS REQUIRED BY THIS SECTION. S 2727. ANNUAL REPORT. ON OR BEFORE THE FIRST OF JANUARY DURING THE TWO CALENDAR YEARS NEXT SUCCEEDING THE EFFECTIVE DATE OF THIS SECTION AND BIENNIALLY THEREAFTER, THE COMMISSIONER SHALL SUBMIT A REPORT REGARDING THE STATUS AND ACCOMPLISHMENTS OF THE PROGRAM AND PROVIDE RECOMMENDATIONS TO THE GOVERNOR, THE TEMPORARY PRESIDENT AND THE MINORI- TY LEADER OF THE SENATE, AND THE SPEAKER AND THE MINORITY LEADER OF THE ASSEMBLY. SUCH REPORT MAY BE SUBMITTED IN CONJUNCTION WITH THE REPORT REQUIRED BY ARTICLE TWENTY-FOUR-F OF THIS CHAPTER.
S 2. This act shall take effect on the one hundred eightieth day after it shall have become law. Effective immediately the commissioner of health is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement the provisions of this act on its effective date. PART B Section 1. The public health law is amended by adding a new article 13-I to read as follows: ARTICLE 13-I IN-UTERO EXPOSURE TO TOBACCO SMOKE PREVENTION SECTION 1399-XX. IN-UTERO EXPOSURE PREVENTION. 1399-YY. PROGRAMS. S 1399-XX. IN-UTERO EXPOSURE PREVENTION. 1. EVERY HEALTHCARE PROVIDER, HEALTHCARE INSURER AND PREGNANCY PROGRAM SHALL DISTRIBUTE INFORMATION ON THE ADVERSE EFFECTS OF SMOKING DURING PREGNANCY FOR BOTH FIRSTHAND AND SECONDHAND SMOKE. SUCH ADVERSE EFFECTS TO THE INFANT INCLUDE LOWER BIRTH RATES, HIGHER INCIDENCE OF ASTHMA AND OBESITY, AND COGNITIVE AND DEVEL- OPMENTAL DAMAGE. 2. EVERY HEALTHCARE PROVIDER SHALL MONITOR EXPECTANT MOTHERS' SMOKING STATUSES AND OFFER CONTINUOUS TAILORED DISCUSSION OF QUITTING SMOKING WITH EXPECTANT MOTHERS DURING THEIR PRENATAL CARE. S 1399-YY. PROGRAMS. THE FOLLOWING PROGRAMS SHALL BE ADDED TO EXISTING TOBACCO CONTROL PROGRAMS FOR PREGNANT WOMEN OR TO OTHER PREGNANCY RELATED PROGRAMS: 1. CARBON MONOXIDE MONITORING; 2. DEPRESSION, SOCIAL SUPPORT AND DOMESTIC VIOLENCE SCREENING AND REFERRALS; 3. REFERRALS FOR SMOKING CESSATION FOR HOUSEHOLD MEMBERS; 4. ONGOING SUPPORT BY COUNSELING AND EDUCATIONAL MATERIALS; AND 5. FINANCIAL INCENTIVES SUCH AS SHIPPING VOUCHER OR DIAPER COUPONS FOR QUITTING FOR MORE THAN FOUR WEEKS. S 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. Provided, that effective immediately the commissioner of health is authorized and directed to promulgate any and all rules and regulations, and take any other measures necessary to implement the provisions of this act on its effective date. PART C Section 1. The public health law is amended by adding a new article 24-F to read as follows: ARTICLE 24-F ASTHMA REPORTING SECTION 2499-B. ASTHMA; DUTY TO REPORT. 2499-C. REPORTING. 2499-D. ASTHMA; REPORTS CONFIDENTIAL. S 2499-B. ASTHMA; DUTY TO REPORT. 1. EVERY PHYSICIAN AND OTHER HEALTH CARE PROVIDER SHALL GIVE NOTICE TO THE DEPARTMENT WITHIN THIRTY DAYS OF EVERY INCIDENT OF AN ASTHMA ATTACK COMING UNDER HIS OR HER CARE, EXCEPT AS OTHERWISE PROVIDED. 2. THE PERSON IN CHARGE OF EVERY ASTHMA REPORTING FACILITY SHALL GIVE NOTICE TO THE DEPARTMENT WITHIN THIRTY DAYS OF EVERY INCIDENT OF AN ASTHMA ATTACK COMING UNDER THE CARE OF SUCH FACILITY.
3. THE DEPARTMENT SHALL ESTABLISH REGULATIONS DESIGNATING WHICH SPECIFIC INFORMATION SHALL BE REPORTED TO THE DEPARTMENT PURSUANT TO THIS SECTION. 4. A PHYSICIAN OR HEALTH CARE PROVIDER OR ASTHMA REPORTING FACILITY WHICH VIOLATES ANY PROVISION OF THIS SECTION SHALL BE SUBJECT TO A CIVIL PENALTY PURSUANT TO SECTION TWELVE OF THIS CHAPTER. 5. THE NOTICES REQUIRED BY THIS SECTION SHALL BE UPON FORMS SUPPLIED BY THE COMMISSIONER AND SHALL CONTAIN SUCH INFORMATION AS SHALL BE REQUIRED BY THE COMMISSIONER. 6. FOR THE PURPOSES OF THIS SECTION, AN "ASTHMA REPORTING FACILITY" MEANS A HOSPITAL AS DEFINED IN ARTICLE TWENTY-EIGHT OF THIS CHAPTER, CLINIC, ANY ORGANIZATION CERTIFIED PURSUANT TO ARTICLE FORTY-FOUR OF THIS CHAPTER, OR OTHER SIMILAR PUBLIC OR PRIVATE INSTITUTION. S 2499-C. REPORTING. 1. THE COMMISSIONER SHALL SUBMIT BIENNIAL REPORTS TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEADER OF THE SENATE AND THE MINORITY LEADER OF THE ASSEMBLY. THE REPORTS SHALL INCLUDE AN EVALUATION OF THE ASTHMA REGISTRY AS IT RELATES TO TIMELINESS, QUALITY AND COMPLETENESS; AN EVAL- UATION OF THE UTILITY OF THE REGISTRY FOR SCIENTIFIC RESEARCH; AN EVALU- ATION OF THE ACCESS, TIMELINESS AND QUALITY OF REPORTING INFORMATION TO RESEARCHERS AND OTHER SIMILAR INDIVIDUALS; AN EVALUATION OF THE REGIS- TRY'S DATA ELEMENTS, INCLUDING TREATMENT, SEVERITY OF DISEASE, OCCUPA- TION, AGE AND RESIDENCE; AN EVALUATION OF THE FEASIBILITY AND UTILITY OF INCLUSION OF OCCUPATIONAL HISTORY AND RESIDENCE HISTORY; AND AN EVALU- ATION OF INTEGRATING THE REGISTRY WITH OTHER DATABASES MAINTAINED BY STATE AGENCIES AND DEPARTMENTS, INCLUDING THE STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM. 2. THE COMMISSIONER SHALL SUBMIT AN ANNUAL REPORT TO THE GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEADER OF THE SENATE AND THE MINORITY LEADER OF THE ASSEMBLY. SUCH REPORT SHALL INCLUDE AN EVALUATION OF WHETHER THE REGISTRY IS ACHIEVING ASTHMA INCIDENCE REGISTRY GOALS ESTABLISHED BY A NATIONALLY RECOGNIZED ASTHMA REGISTRY ORGANIZATION, INCLUDING NUMERICAL GOALS CONCERNING TIMELINESS, QUALITY, AND COMPLETENESS. S 2499-D. ASTHMA; REPORTS CONFIDENTIAL. THE REPORTS OF ASTHMA ATTACKS MADE PURSUANT TO THE PROVISIONS OF THIS ARTICLE SHALL NOT BE DIVULGED OR MADE PUBLIC BY ANY PERSON SO AS TO DISCLOSE THE IDENTITY OF ANY PERSON TO WHOM THEY RELATE, EXCEPT IN SO FAR AS MAY BE AUTHORIZED IN THE SANI- TARY CODE. S 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the commissioner of health is authorized to promulgate any and all rules and regulations and take any other measures necessary to implement this act on its effective date on or before such date. PART D 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: 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 RESPIR- ATORY DISEASES, diabetes or other chronic health conditions as may be specified by the department; or have experienced or are likely to expe- rience 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 E Section 1. Subdivision 1 of 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: 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 conditions. The program shall use recommendations and goals of the United States departments of agricul- ture and health and human services, the surgeon general and centers for disease control in developing 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.
S 2. Paragraphs (f) and (g) of subdivision 2 of section 2599-b of the public health law, as amended by section 88 of part B of chapter 58 of the laws of 2005, are amended and a new paragraph (h) is added to read as follows: (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 (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, EMPHYSEMA, CHRONIC BRONCHITIS AND OTHER CHRONIC RESPIRATORY DISEASES TO ENABLE ADULTS AND CHILDREN TO SAFELY INCREASE PHYSICAL ACTIVITY TO HELP CURB THE INCIDENCE OF OBESITY. S 3. This act shall take effect immediately. PART F Section 1. Legislative intent. The legislature recognizes that expo- sure to second-hand smoke is known to cause cancer, pneumonia, asthma, bronchitis and heart disease in humans, and to trigger asthma attacks. The legislature finds that prohibiting smoking within a presumptively reasonable minimum distance of fifteen feet from entrances and exits that serve enclosed areas where smoking is prohibited is consistent with such prohibition. This legislation will apply to any individual occupy- ing such area with the purpose of smoking, but provides exceptions for individuals passing through such area. Therefore, the legislature finds that smoking in such area shall be prohibited and owners and other indi- viduals in control of such area are recommended to post signs indicating no smoking areas and providing for fines for violations. S 2. The public health law is amended by adding a new section 1399-o-1 to read as follows: S 1399-O-1. SMOKING RESTRICTIONS; CERTAIN OUTDOOR AREAS. 1. SMOKING IS PROHIBITED WITHIN A PRESUMPTIVELY REASONABLE MINIMUM DISTANCE OF FIFTEEN FEET FROM ENTRANCES OR EXITS OF PUBLIC BUILDINGS OR PRIVATE BUILDINGS THAT CONTAIN STATE OR MUNICIPAL OFFICES OR EDUCATIONAL FACILI- TIES FOR ELEMENTARY OR SECONDARY SCHOOL STUDENTS. SUCH DISTANCE SHALL BECOME A DESIGNATED NO SMOKING ZONE. 2. LOCAL HEALTH DEPARTMENTS ARE AUTHORIZED TO ADOPT REGULATIONS AS ARE REQUIRED TO IMPLEMENT THIS SECTION. ANY PENALTY ASSESSED AND RECOVERED IN AN ACTION BROUGHT UNDER THIS SECTION SHALL BE PAID TO AND USED BY THE MUNICIPALITY BRINGING THE ACTION. 3. THIS SECTION SHALL NOT APPLY TO INDIVIDUALS WALKING THROUGH THE DESIGNATED NO SMOKING ZONE OF SUCH AREA FOR THE PURPOSE OF GETTING TO ANOTHER DESTINATION, BUT SHALL ONLY APPLY TO INDIVIDUALS OCCUPYING THE DESIGNATED NO SMOKING ZONE FOR THE PURPOSE OF SMOKING.
4. ANY PERSON VIOLATING THE PROVISIONS OF THIS SECTION SHALL BE GUILTY OF A VIOLATION, AND IS SUBJECT TO A FINE OF THIRTY-FIVE DOLLARS. 5. THE COMMISSIONER MAY RECOMMEND DESIGNS FOR SIGNS WHICH MAY BE USED BY THE OWNERS, OPERATORS, MANAGERS, EMPLOYERS OR OTHER PERSONS, AT THEIR OPTION, WHO CONTROL AREAS WHERE SMOKING IS PROHIBITED PURSUANT TO SECTION THIRTEEN HUNDRED NINETY-NINE-O OF THIS ARTICLE. SUCH SIGNS SHALL INCLUDE THE WARNING THAT "SMOKING IN THIS AREA IS PUNISHABLE BY LAW AND ALL VIOLATORS SHALL BE SUBJECT TO A FINE OF THIRTY-FIVE DOLLARS." 6. NOTHING CONTAINED IN THIS SECTION IS INTENDED TO REGULATE SMOKING IN A PRIVATE RESIDENCE OR IN THE GENERAL PUBLIC OUTDOORS, EXCEPTING PLACES IN WHICH SMOKING IS PROHIBITED THROUGH THE LOCAL FIRE DEPARTMENT, OR BY OTHER LAW, ORDINANCE, OR REGULATION. S 3. This act shall take effect on the one hundred twentieth day after it shall have become a law. PART G Section 1. The education law is amended by adding a new section 3001-e to read as follows: S 3001-E. ASTHMA EMERGENCIES; TRAINING IN IDENTIFICATION AND RESPONSE. THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH, SHALL ESTABLISH STANDARDS FOR THE TRAINING OF TEACHERS AND OTHER APPROPRIATE PERSONNEL IN IDENTIFYING AND RESPONDING TO ASTHMA EMERGENCIES IN PUPILS AND OTHER PERSONS. SUCH STANDARDS SHALL SPECIFY MINIMUM LEVELS OF KNOW- LEDGE AND PROCEDURES TO BE FOLLOWED. SUCH STANDARDS SHALL PERMIT TRAIN- ING TO BE GIVEN BY PERSONS OR ORGANIZATIONS DEEMED QUALIFIED TO DO SO BY THE COMMISSIONER. S 2. This act shall take effect one year after it shall have become a law. PART H Section 1. The real property law is amended by adding a new section 235-h to read as follows: S 235-H. RESIDENTIAL RENTAL PROPERTY SMOKING POLICIES. EVERY RENTAL AGREEMENT FOR A DWELLING UNIT, IN A MULTIPLE DWELLING BUILDING WITH FOUR OR MORE UNITS, SHALL INCLUDE A DISCLOSURE OF THE SMOKING POLICY FOR THE PREMISES ON WHICH THE DWELLING UNIT IS LOCATED. THE DISCLOSURE MUST STATE WHETHER SMOKING IS PROHIBITED ON THE PREMISES, ALLOWED ON THE ENTIRE PREMISES OR ALLOWED IN LIMITED AREAS ON THE PREMISES. IF THE SMOKING POLICY ALLOWS SMOKING IN LIMITED AREAS ON THE PREMISES, THE DISCLOSURE MUST IDENTIFY THE AREAS ON THE PREMISES WHERE SMOKING IS ALLOWED. S 2. This act shall take effect on the first of January next succeed- ing the date on which it shall have become a law. PART I Section 1. The education law is amended by adding a new section 1527-a to read as follows: S 1527-A. IDLING MOTOR VEHICLES ON SCHOOL GROUNDS. 1. ON OR BEFORE SEPTEMBER FIRST, TWO THOUSAND FIFTEEN AND CONSISTENT WITH THE COMMIS- SIONER'S REGULATIONS, ADOPTED PURSUANT TO SECTION THIRTY-SIX HUNDRED THIRTY-SEVEN OF THIS CHAPTER, THE BOARD OF EDUCATION OR BOARD OF TRUS- TEES OF EVERY SCHOOL DISTRICT AND THE GOVERNING BODY OF EVERY PRIVATE ELEMENTARY OR SECONDARY SCHOOL IN THE STATE SHALL PROMULGATE AND IMPLE-
MENT RULES PROHIBITING THE ENGINE OF ANY MOTOR VEHICLE, AS DEFINED IN SECTION ONE HUNDRED TWENTY-FIVE OF THE VEHICLE AND TRAFFIC LAW, TO REMAIN IDLING FOR MORE THAN ONE MINUTE WHILE SUCH VEHICLE IS PARKED OR STANDING ON SCHOOL GROUNDS, ADJACENT TO SCHOOL GROUNDS, OR IN FRONT OF ANY SCHOOL WHILE LOADING OR OFF LOADING PASSENGERS. 2. EACH SCHOOL DISTRICT AND PRIVATE ELEMENTARY AND SECONDARY SCHOOL SHALL CONSPICUOUSLY POST SIGNS UPON, ADJACENT AND IN FRONT OF SCHOOL GROUNDS ADVISING OPERATORS OF MOTOR VEHICLES OF THE PROVISIONS OF THE RULES ADOPTED PURSUANT TO SUBDIVISION ONE OF THIS SECTION. S 2. This act shall take effect immediately. PART J Section 1. Section 916 of the education law, as amended by chapter 524 of the laws of 2006, is amended to read as follows: S 916. Pupils afflicted with asthma OR OTHER POTENTIALLY LIFE-THREAT- ENING RESPIRATORY ILLNESSES. The board of education or trustees of each school district and board of cooperative educational services shall allow pupils who have been diagnosed by a physician or other duly authorized health care provider with a severe OR MODERATELY SEVERE asth- matic condition OR OTHER POTENTIALLY LIFE-THREATENING RESPIRATORY ILLNESS to carry and use a prescribed inhaler during the school day, with the written permission of a physician or other duly authorized health care provider, and parental consent, based on such physician's or provider's determination that such pupil is subject to sudden asthmatic attacks [severe enough to] THAT CAN debilitate such pupil. A record of such permission shall be maintained in the school office. In addition, upon the written request of a parent or person in parental relation, the board of education or trustees of a school district and board of cooper- ative educational services shall allow such pupils to maintain an extra such inhaler in the care and custody of a registered professional nurse OR OTHER DESIGNATED RESPONSIBLE PERSON employed by such district or board of cooperative educational services. Nothing in this section shall require a school district or board of cooperative educational services to retain a school nurse solely for the purpose of taking custody of a spare inhaler, or require that a school nurse be available at all times in a school building for such purpose. S 2. The education law is amended by adding a new section 921 to read as follows: S 921. USE OF NEBULIZER. 1. EVERY SCHOOL DISTRICT AND BOARD OF COOPER- ATIVE EDUCATIONAL SERVICES IN THIS STATE MAY MAINTAIN ONE OR MORE NEBU- LIZERS IN THE OFFICE OF THE SCHOOL NURSE OR IN A SIMILAR ACCESSIBLE LOCATION. 2. THE COMMISSIONER, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH, MAY PROMULGATE REGULATIONS FOR THE ADMINISTRATION OF ASTHMA MEDICATION THROUGH THE USE OF A NEBULIZER BY THE SCHOOL NURSE OR PERSON AUTHORIZED BY REGULATION. THE REGULATIONS MAY INCLUDE: A. A REQUIREMENT THAT EACH CERTIFIED NURSE OR OTHER PERSON AUTHORIZED TO ADMINISTER ASTHMA MEDICATION IN SCHOOLS RECEIVE TRAINING IN AIRWAY MANAGEMENT AND IN THE USE OF NEBULIZERS AND INHALERS CONSISTENT WITH NATIONALLY RECOGNIZED STANDARDS; AND B. A REQUIREMENT THAT EACH PUPIL AUTHORIZED TO USE ASTHMA MEDICATION PURSUANT TO SUBDIVISION ONE OF SECTION NINE HUNDRED SIXTEEN OF THIS ARTICLE OR A NEBULIZER HAVE AN ASTHMA TREATMENT PLAN PREPARED BY THE PHYSICIAN OF THE PUPIL, WHICH IDENTIFY, AT A MINIMUM, ASTHMA TRIGGERS,
THE TREATMENT PLAN, AND SUCH OTHER ELEMENTS AS SHALL BE DETERMINED BY THE REGENTS. S 3. This act shall take effect on the one hundred eightieth day after it shall have become a law; provided, however, that effective immediate- ly the commissioner of education is authorized to promulgate rules and regulations for the implementation of this act on such effective date. PART K Section 1. Subdivision 7 of section 33-0303 of the environmental conservation law, as added by chapter 85 of the laws of 2010, is amended to read as follows: 7. The commissioner, in consultation with the commissioner of educa- tion and the commissioner of health, shall develop guidance AND REGU- LATIONS on pesticide alternatives to facilitate compliance with section four hundred nine-k of the education law and three hundred ninety-g of the social services law. PROVIDED, FURTHER, THAT SUCH PESTICIDE ALTERNA- TIVES SHALL HELP TO MINIMIZE THE INCIDENCE OF ASTHMA ATTACKS IN PUBLIC AND PRIVATE BUILDINGS AND RESIDENCES, WHILE STILL EFFECTIVELY CONTROL- LING THE TARGETED PEST OR ORGANISM. SUCH REGULATIONS SHALL PROVIDE FOR THE USE OF THE LEAST TOXIC PESTICIDE OR PESTICIDES, WHICH EFFECTIVELY ERADICATES THE TARGETED PEST OR ORGANISM. S 2. This act shall take effect immediately. PART L Section 1. The public buildings law is amended by adding a new section 143 to read as follows: S 143. CURTAIL USE OF CHEMICALS THAT INDUCE OR TRIGGER ASTHMA ATTACKS. 1. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE CONTRARY, THE SUPERINTENDENT OF EVERY STATE PUBLIC BUILDING, AND OF EVERY TRANSPORTA- TION FACILITY OPERATED BY A PUBLIC AUTHORITY, PUBLIC BENEFIT CORPORATION OR MUNICIPALITY SHALL TO THE BEST OF HIS OR HER ABILITY CURTAIL THE USE OF CLEANING MATERIALS OR CHEMICALS, EXPOSURE TO WHICH MAY CAUSE EITHER THE BUILDING CLEANING STAFF OR OTHER PERSONS WHO ENTER SUCH BUILDING TO DEVELOP THE DISEASE OF ASTHMA, OR WHICH MAY EXACERBATE OR TRIGGER AN ASTHMA ATTACK. 2. A DETERMINATION OF WHICH OR THE QUANTITY OR CONCENTRATION OF SUCH CLEANING MATERIALS OR CHEMICALS EXPOSURE TO WHICH MAY CAUSE PERSONS TO DEVELOP THE DISEASE OF ASTHMA, OR WHICH MAY EXACERBATE OR TRIGGER AN ASTHMA ATTACK, SHALL BE MADE BY THE COMMISSIONER OF HEALTH WHO SHALL PROMULGATE A LIST OF SUCH CLEANING MATERIALS OR CHEMICALS. S 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. S 3. 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 4. This act shall take effect immediately provided, however, that the applicable effective date of Parts A through L of this act shall be as specifically set forth in the last section of such Parts.

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