This bill has been amended

Bill S4528-2013

Relates to the statewide immunization information system and the administration of certain immunizations

Relates to the statewide immunization information system and the administration of certain immunizations.

Details

Actions

  • Jun 10, 2013: 1ST REPORT CAL.1168
  • Apr 8, 2013: REFERRED TO HEALTH

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Health - Jun 10, 2013
Ayes (12): Hannon, Ball, Farley, Felder, Fuschillo, Golden, Larkin, Savino, Young, Montgomery, Hassell-Thompson, O'Brien
Ayes W/R (5): Seward, Rivera, Adams, Peralta, Hoylman

Memo

BILL NUMBER:S4528

TITLE OF BILL: An act to amend the public health law, in relation to the statewide immunization information system; to amend the education law, in relation to the administration of certain immunizations; and to amend chapter 563 of the laws of 2008, amending the education law and the public health law relating to immunizing agents to be administered to adults by pharmacists and chapter 116 of the laws of 2012, amending the education law relating to authorizing a licensed pharmacist and certified nurse practitioner to administer certain immunizing agents, in relation to making the provisions thereof permanent

Purpose: This bill would enhance the effectiveness of the State's efforts to reduce the incidence of vaccine-preventable disease by: (1) expanding access to information maintained in the New York Statewide Immunization Information System (NYSIIS) to colleges, professional schools, technical schools, children's camps, cities, the Indian Health Service, tribal nations and academic researchers; (2) permitting adults to give oral consent rather than written consent for their immunizations to be recorded in NYSIIS; and (3) expanding and making permanent the authority of qualified pharmacists to administer certain immunizations to adults.

Summary of Provisions:

Section 1 of the bill would amend Public Health Law (PHL) § 2168(2)(a) to include colleges, professional and technical schools, and children's overnight camps and summer day camps, as "authorized users" of NYSIIS and the New York City Citywide Immunization Registry (CIR).

Section 2. of the bill would amend PHL § 2168(3)(a) to provide that individuals who are 19 years or older can consent to have their immunizations registered in NYSIIS and CIR verbally rather than in writing.

Section 3 of the bill would amend PHL § 2168(5)(f) to make a technical correction to a statutory reference relating to exemptions from immunizations.

Section 4 of the bill would amend PHL § 2168(8)(d) to permit colleges and professional and technical schools to access NYSIIS and CIR for the purpose of verifying immunization status for eligibility for admission and to allow access by children's overnight camps and summer day camps for verifying immunization status of children attending camp.

Section 5 of the bill would add new PHL § 2168(8)(e) to authorize institutes of higher education, medical research centers or similar institutions to access de-identified information in NYSIIS or CIR for the purpose of epidemiological or other public health research, if approved by the Commissioner of Health (Commissioner) or the Commissioner of the New York City Department of Health and Mental Hygiene (DOHMH), as appropriate.

Section 6 of the bill would amend PHL § 2168(11) to permit patient specific information contained in NYSIIS or CIR to be shared with city

registries and registries maintained by the Indian Health Service or tribal nations recognized by the State or the United States

Section 7 of the bill would amend Education Law § 6527(7) to allow a licensed physician to issue a patient specific or non-patient specific regimen to a licensed pharmacist for immunizations to prevent acute herpes zoster, tetanus, diphtheria, or pertussis.

Section 8 of the bill would amend Education Law § 6909(7) to allow a certified nurse practitioner to issue a patient specific or non-patient specific regimen to a licensed pharmacist for immunizations to prevent acute herpes zoster, tetanus, diphtheria, or pertussis.

Section 9 of the bill would amend Education Law § 6801(2), (4) and (5) so that pharmacists no longer need report the administration of an immunization to the Department of Health (DOH) and to eliminate the requirement for a report by the Commissioner to the Governor and Legislature on the impact of permitting pharmacist immunizations on the supply of vaccines.

Section 10 of the bill would amend Education Law § 6802(22) so that (1) pharmacists who are appropriately certified may administer acute herpes zoster, tetanus, diphtheria, and pertussis immunizations to adults; (2) for non-patient specific regimens, a licensed physician or certified nurse practitioner is not required to have a practice site in the county in which the immunization is administered; and (3) the Commissioner may issue a statewide non-patient specific regimen to pharmacists for immunizations if he or she determines that there is an outbreak of disease or the imminent threat of an outbreak of disease.

Section 11 of the bill would amend Chapter 563 of the Laws of 2008 to make permanent the authority of pharmacists with appropriate certification to administer immunizations against influenza and pneumoccocal disease.

Section 12 of the bill would amend Chapter 116 of the Laws of 2012, 5, to eliminate the requirement that DOH submit a report to the Governor and Legislature on insurance coverage for acute herpes zoster immunizations in New York State. Section 12 also would amend Chapter 116 of the Laws of 2012, § 6, to make permanent the authority of pharmacists with appropriate certification to administer immunizations against acute herpes zoster disease.

Section 13 of the bill provides that the bill would take effect immediately.

Existing Law: PHL § 2164 requires all children under the age of 18 to receive immunization against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, Haemophilus influenzae type B, pertussis, tetanus, pneumococcal disease, and hepatitis B.

PHL § 2165 requires students to provide proof of immunization against measles, mumps and rubella upon enrollment at a college or university within the State.

PHL § 2168 establishes NYSIIS. Education Law §§ 6801 and 6802 authorize pharmacists to administer adult immunizations against influenza, pneumococcal and acute herpes zoster disease.

Education Law §§ 6527 and 6909 authorize licensed physicians and certified nurse practitioners to issue patient specific and non-patient specific orders to pharmacists for adult immunizations to prevent influenza, pneumococcal and acute herpes zoster disease.

Legislative History: This is a new bill.

Statement in Support: Easing the incorporation of adult immunization information into NYSIIS would help the program meet its overarching goal: the establishment of a fully-developed database of complete, accurate and secure immunization records. As a central repository for immunization records, NYSIIS - the statewide system which encompasses New York City's CIR - aids, coordinates and promotes cost-effective disease prevention and control efforts. NYSIIS tracks the immunizations a person has received, even if a patient sees multiple providers, helping DOH sustain high immunization rates and low disease levels through the efficient management of information Thus, this bill would enhance the effectiveness of NYSIIS in several ways.

First, some colleges and universities, including the State University of New York and the City University of New York, have health care providers who are "authorized users" of NYSIIS and CIR with respect to persons seeking or receiving a health care service from that provider, Post-secondary schools, however, are not otherwise currently "authorized users" of NYSIIS or CIR and therefore cannot use the database to efficiently assess the immunization status of their students. By permitting these institutions, as well as professional and technical schools and overnight and summer camps, to access NYSIIS and CIR, they would more easily verify the immunization status of incoming students as required under PHL § 2165.

Second, immunizations of adults currently are recorded in NYSIIS only if an individual consents in writing. This bill would let them consent orally and would allow an adult, who is reluctant to sign a written document the opportunity to be included in NYSIIS, while maintaining his or her ability to refuse to give oral consent and still receive immunizations.

Third, the bill would permit de-identified NYSIIS data to be shared with academic institutions or similar entities conducting public health research. Such research is expected to include analysis of trends and patterns of immunization, which would help identify populations at risk and disparities among immunization coverage levels, and would give DOH access to expertise in data analysis, research and evaluation that might otherwise be unavailable. Institutions would be required to seek approval for such access, which would be granted for the NYSIIS database only in the discretion of DOH or, for CIR, in the discretion of DOHMH.

Fourth, PHL § 2168 currently permits NYSIIS to share immunization information with "other state" registries pursuant to written agreements requiring such other registries to adhere to national standards protecting the integrity of the information. This bill would

permit NYSIIS similarly to share registrant-specific information, including lead test records, with registries maintained by cities, the Indian Health Service and tribal nations recognized by the State or the United States, enhancing their ability to verify immunizations among their populations while increasing the amount of immunization information available in NYSIIS.

Fifth, the bill would improve overall efforts to reduce the incidence of vaccine-preventable disease by expanding access to immunizations in the pharmacy setting. Currently, a licensed physician or a certified nurse practitioner may issue an order to a licensed pharmacist located in the same or an adjoining county for the administration of immunizations to prevent influenza, pneumococcal disease or acute herpes zoster (commonly known as shingles) and medications required for emergency treatment of anaphylaxis. The pharmacist must undergo training and be certified to provide such immunizations pursuant to regulations issued by the State Education Department (SED).

Sixth, the provisions that permit pharmacists to administer acute herpes zoster immunizations are scheduled to sunset on July 1, 2015, and that permit pharmacists to administer influenza and pneumococcal immunizations are scheduled to sunset on March 31, 2016. Because the provisions have successfully expanded access to important immunizations, this bill would make them permanent. In addition, the bill would authorize pharmacists, who receive certification to offer immunizations, pursuant to SED regulations, to administer immunizations against acute herpes zoster disease to adults, pursuant to a non-patient specific regimen The bill would also authorize certified pharmacists to administer immunizations against tetanus, diphtheria, or pertussis ("Tdap") to adults, thus expanding access to such immunizations In particular, pertussis activity continues to rise nationally, as well as throughout New York State. Infants too young to be immunized are at highest risk of experiencing severe consequences of pertussis, including death.

Seventh, the bill would make it easier for pharmacists in smaller counties to obtain non-patient specific orders from physicians and nurse practitioners. Currently, if a county has a population of 75,000 or less, pharmacists may immunize under a standing order written by a health care provider from an adjacent county. Eliminating this provision and authorizing physicians and nurse practitioners who may not have a practice site in the same or adjoining county in which the immunization is administered to issue standing orders would expand the options available to pharmacists operating in small counties across the State. Pharmacists in counties previously unable to immunize because of a lack of available licensed physicians or certified nurse practitioners allowed to issue non-patient specific regimens will now be able to reach out to providers in other counties for the necessary standing order. Standing orders are an effective means of increasing immunization rates and are recommended by the United States Preventive Services Task Force (USPSTF) in its Guide to Community Preventive Services.

Eight, the bill would permit the Commissioner to issue a statewide non-patient specific regimen to pharmacists for immunizations if he or she determines that there is an outbreak of disease or the imminent threat of an outbreak of disease Allowing the Commissioner to issue a

statewide order for a non-patient specific regimen during an outbreak of disease or the imminent threat of an outbreak of disease will serve to expedite vaccination efforts in times of emergency. Local health departments and local physicians faced with responding to an outbreak in their community would be relieved of the burden of having to issue such regimens themselves.

Finally, the bill would eliminate reporting requirements that DOH believes to be unnecessary, including the reporting of each pharmacist administration of an immunization to DOH, the submission of a report on the impact of pharmacist immunizations on the supply of vaccines, and the submission of a report on insurance coverage for acute herpes zoster immunizations in New York State.

Budget Implications: This bill is not anticipated to have a fiscal impact on the State.

Effective Date: This bill would take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 4528 2013-2014 Regular Sessions IN SENATE April 8, 2013 ___________
Introduced by Sen. HANNON -- (at request of the Department of Health) -- 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 the statewide immunization information system; to amend the education law, in relation to the administration of certain immunizations; and to amend chapter 563 of the laws of 2008, amending the education law and the public health law relating to immunizing agents to be administered to adults by pharmacists and chapter 116 of the laws of 2012, amending the education law relating to authorizing a licensed pharmacist and certified nurse practitioner to administer certain immunizing agents, in relation to making the provisions thereof permanent THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph (a) of subdivision 2 of section 2168 of the public health law, as amended by section 7 of part A of chapter 58 of the laws of 2009, is amended to read as follows: (a) The term "authorized user" shall mean any person or entity author- ized to provide information to or to receive information from the state- wide immunization information system and shall include health care providers and their designees, as defined in paragraph (d) of this subdivision, schools as defined in paragraph a of subdivision one of section twenty-one hundred sixty-four of this title, COLLEGES AS DEFINED IN SECTION TWO OF THE EDUCATION LAW, PROFESSIONAL AND TECHNICAL SCHOOLS AS REFERRED TO IN THE DEFINITION OF HIGHER EDUCATION IN SECTION TWO OF THE EDUCATION LAW, CHILDREN'S OVERNIGHT CAMPS AND SUMMER DAY CAMPS AS DEFINED IN SECTION THIRTEEN HUNDRED NINETY-TWO OF THIS CHAPTER, third party payer as defined in paragraph (f) of this subdivision, local health districts as defined by paragraph (c) of subdivision one of section two of this chapter, local social services districts and the office of children and family services with regard to children in their
legal custody, and WIC programs as defined in paragraph (g) of this subdivision. An authorized user may be located outside New York state. An entity other than a local health district shall be an authorized user only with respect to a person seeking or receiving a health care service from the health care provider, a person enrolled or seeking to be enrolled in the school, a person insured by the third party payer, a person in the custody of the local social services district or the office of children and family services, or a person seeking or receiving services through WIC programs, as the case may be. S 2. Paragraph (a) of subdivision 3 of section 2168 of the public health law, as amended by section 7 of part A of chapter 58 of the laws of 2009, is amended to read as follows: (a) Any health care provider who administers any vaccine to a person less than nineteen years of age or, on or after September first, two thousand nine, conducts a blood lead analysis of a sample obtained from a person under eighteen years of age in accordance with paragraph (h) of subdivision two of this section; and immunizations received by a person less than nineteen years of age in the past if not already reported, shall report all such immunizations and the results of any blood lead analysis to the department in a format prescribed by the commissioner within fourteen days of administration of such immunizations or of obtaining the results of any such blood lead analysis. Health care providers administering immunizations to persons less than nineteen years of age in the city of New York shall report, in a format prescribed by the city of New York commissioner of health and mental hygiene, all such immunizations to the citywide immunization registry. The commissioner, and for the city of New York the commissioner of health and mental hygiene, shall have the discretion to accept for inclusion in the system information regarding immunizations administered to individuals nineteen years of age or older with the [express written] consent of the [vaccine] VACCINEE. Health care providers who conduct a blood lead analysis on a person under eighteen years of age and who report the results of such analysis to the city of New York commissioner of health and mental hygiene pursuant to New York city reporting requirements shall be exempt from this requirement for reporting blood lead analysis results to the state commissioner of health; provided, however, blood lead analysis data collected from physician office labo- ratories by the commissioner of health and mental hygiene of the city of New York pursuant to the health code of the city of New York shall be provided to the department in a format prescribed by the commissioner. S 3. Paragraph (f) of subdivision 5 of section 2168 of the public health law, as amended by section 7 of part A of chapter 58 of the laws of 2009, is amended to read as follows: (f) The immunization status of children exempt from immunizations pursuant to subdivision eight of [this] section TWENTY-ONE HUNDRED SIXTY-FOUR OF THIS TITLE and a parent claiming exemption pursuant to subdivision nine of section twenty-one hundred sixty-four of this title shall be reported by the health care provider. S 4. Paragraph (d) of subdivision 8 of section 2168 of the public health law, as amended by section 7 of part A of chapter 58 of the laws of 2009, is amended to read as follows: (d) The following authorized users shall have access to the statewide immunization information system and the blood lead information in such system and the citywide immunization registry for the purposes stated in this paragraph: (i) schools for verifying immunization status for eligi- bility for admission; (ii) COLLEGES FOR VERIFYING IMMUNIZATION STATUS
FOR ELIGIBILITY FOR ADMISSION; (III) PROFESSIONAL AND TECHNICAL SCHOOLS FOR VERIFYING IMMUNIZATION STATUS FOR ELIGIBILITY FOR ADMISSION; (IV) CHILDREN'S OVERNIGHT CAMPS AND SUMMER DAY CAMPS FOR VERIFYING IMMUNIZA- TION STATUS OF CHILDREN ATTENDING CAMP; (V) third party payer for performing quality assurance, accountability and outreach, relating to enrollees covered by the third party payer; [(iii)] (VI) commissioners of local social services districts with regard to a child in his/her legal custody; [(iv)] (VII) the commissioner of the office of children and family services with regard to children in their legal custody, and for quality assurance and accountability of commissioners of local social services districts, care and treatment of children in the custody of commissioners of local social services districts; and [(v)] (VIII) WIC programs for the purposes of verifying immunization and lead testing status for those seeking or receiving services. S 5. Subdivision 8 of section 2168 of the public health law is amended by adding a new paragraph (e) to read as follows: (E) INSTITUTES OF HIGHER EDUCATION, MEDICAL RESEARCH CENTERS OR OTHER INSTITUTIONS ENGAGED IN EPIDEMIOLOGICAL RESEARCH OR OTHER PUBLIC HEALTH RESEARCH SHALL HAVE ACCESS TO DE-IDENTIFIED REGISTRANT INFORMATION IN THE STATEWIDE IMMUNIZATION INFORMATION SYSTEM OR THE CITYWIDE IMMUNIZA- TION REGISTRY FOR RESEARCH PURPOSES IF APPROVED BY THE COMMISSIONER OR THE COMMISSIONER OF THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE OF THE CITY OF NEW YORK, AS APPROPRIATE. S 6. Subdivision 11 of section 2168 of the public health law, as amended by section 7 of part A of chapter 58 of the laws of 2009, is amended to read as follows: 11. The commissioner, or in the city of New York, the commissioner of the department of health and mental hygiene, may provide registrant specific immunization AND LEAD TEST records to other state OR CITY registries AND REGISTRIES MAINTAINED BY THE INDIAN HEALTH SERVICE AND TRIBAL NATIONS RECOGNIZED BY THE STATE OR THE UNITED STATES pursuant to a written agreement requiring that the [out-of-state] OTHER registry conform to national standards for maintaining the integrity of the data and will not be used for purposes inconsistent with the provisions of this section. S 7. Subdivision 7 of section 6527 of the education law, as amended by chapter 116 of the laws of 2012, is amended to read as follows: 7. [(a)] A licensed physician may prescribe and order a PATIENT SPECIFIC ORDER OR non-patient specific regimen to a licensed pharmacist, pursuant to regulations promulgated by the commissioner, and consistent with the public health law, for administering immunizations to prevent influenza [or], pneumococcal, ACUTE HERPES ZOSTER, TETANUS, DIPHTHERIA OR PERTUSSIS disease and medications required for emergency treatment of anaphylaxis. Nothing in this subdivision shall authorize unlicensed persons to administer immunizations, vaccines or other drugs. [(b) A licensed physician may prescribe and order a patient specific order to a licensed pharmacist, pursuant to regulations promulgated by the commissioner, and consistent with the public health law, for admin- istering immunizations to prevent acute herpes zoster.] S 8. Subdivision 7 of section 6909 of the education law, as amended by chapter 116 of the laws of 2012, is amended to read as follows: 7. [(a)] A certified nurse practitioner may prescribe and order a PATIENT SPECIFIC ORDER OR non-patient specific regimen to a licensed pharmacist, pursuant to regulations promulgated by the commissioner, and consistent with the public health law, for administering immunizations to prevent influenza [or], pneumococcal, ACUTE HERPES ZOSTER, TETANUS,
DIPHTHERIA, OR PERTUSSIS disease and medications required for emergency treatment of anaphylaxis. Nothing in this subdivision shall authorize unlicensed persons to administer immunizations, vaccines or other drugs. [(b) A certified nurse practitioner may prescribe and order a patient specific regimen to a licensed pharmacist, pursuant to regulations promulgated by the commissioner, and consistent with the public health law, for administering immunizations to prevent acute herpes zoster.] S 9. Subdivisions 2, 4 and 5 of section 6801 of the education law, subdivisions 2 and 4 as added by chapter 563 of the laws of 2008 and subdivision 5 as added by chapter 116 of the laws of 2012, are amended to read as follows: 2. A licensed pharmacist may execute a non-patient specific regimen prescribed or ordered by a licensed physician or certified nurse practi- tioner, pursuant to rules and regulations promulgated by the commission- er. When a licensed pharmacist administers an immunizing agent, he or she shall: (a) report such administration to the patient's attending primary health care practitioner or practitioners, if any, pursuant to rules and regulations of the commissioner; AND (b) provide information to the patient on the importance of having a primary health care practitioner, developed by the commissioner of health[; and (c) report such administration, absent of any individually identifi- able health information, to the department of health in a manner required by the commissioner of health]. 4. [The commissioner of health, in consultation with the commissioner, shall prepare and submit a report to the governor and the legislature, on or before December thirty-first, two thousand eleven, reporting the results and evaluating the effectiveness and impact, if any, of imple- mentation of subdivision two of this section upon the supply of such immunizing agents for the prevention of influenza and pneumococcal disease, upon the geographical distribution of such agents, and upon the distribution of such agents among health care providers, including physicians, and pharmacies in New York state. 5.] When administering an immunization in a pharmacy, the licensed pharmacist shall provide an area for the immunization that provides for a patient's privacy. S 10. Subdivision 22 of section 6802 of the education law, as amended by chapter 116 of the laws of 2012, is amended to read as follows: 22. "Administer", for the purpose of section sixty-eight hundred one of this article, means the direct application of an immunizing agent to adults, whether by injection, ingestion or any other means, pursuant to [a.] a patient specific order or non-patient specific regimen prescribed or ordered by a physician or certified nurse practitioner, who has a practice site in the county in which the immunization is administered, for immunizations to prevent influenza [or], pneumococcal, ACUTE HERPES ZOSTER, TETANUS, DIPHTHERIA OR PERTUSSIS disease and medications required for emergency treatment of anaphylaxis [or b. a patient specif- ic order prescribed or ordered by a physician or certified nurse practi- tioner for immunizations to prevent acute herpes zoster]. [If] FOR NON-PATIENT SPECIFIC REGIMENS, [the county where the immunization is to be administered has a population of seventy-five thousand or less, then] the licensed physician or certified nurse practitioner [may be in an adjoining county. Such administration shall be limited to immunizing agents to prevent influenza or pneumococcal disease and medications required for emergency treatment of anaphylaxis] IS NOT REQUIRED TO HAVE
A PRACTICE SITE IN THE COUNTY IN WHICH THE IMMUNIZATION IS ADMINISTERED. IF THE COMMISSIONER OF HEALTH DETERMINES THAT THERE IS AN OUTBREAK OF DISEASE, OR THAT THERE IS THE IMMINENT THREAT OF AN OUTBREAK OF DISEASE, THEN THE COMMISSIONER OF HEALTH MAY ISSUE A NON-PATIENT SPECIFIC REGIMEN APPLICABLE STATEWIDE. S 11. Section 8 of chapter 563 of the laws of 2008, amending the education law and the public health law relating to immunizing agents to be administered to adults by pharmacists, as amended by chapter 316 of the laws of 2011, is amended to read as follows: S 8. This act shall take effect on the ninetieth day after it shall have become a law [and shall expire and be deemed repealed March 31, 2016]. S 12. Sections 5 and 6 of chapter 116 of the laws of 2012, amending the education law relating to authorizing a licensed pharmacist and certified nurse practitioner to administer certain immunizing agents, are amended to read as follows: S 5. [The commissioner of health, in consultation with the superinten- dent of financial services and the commissioner of education, shall prepare and submit a report to the governor and the legislature, on or before October first, two thousand fourteen, regarding the rates of health insurance plan coverage for immunizations to prevent acute herpes zoster in New York state. This information shall include, but not be limited to, the total number of people receiving immunizations to prevent acute herpes zoster from health care providers as compared to pharmacies in New York state; the rates of coverage from health insur- ance plans, including Medicare, for people receiving immunizations to prevent acute herpes zoster from health care providers as compared to pharmacies in New York state; the amount of co-pays and other fees required by health insurance plans, including Medicare, for people receiving immunizations to prevent acute herpes zoster from health care providers as compared to pharmacies in New York state; and a list of health insurance plans that do not provide coverage for people receiving immunizations to prevent acute herpes zoster from health care providers as compared to pharmacies in New York state as well as the amount or amounts that are charges to an individual receiving immunizations to prevent herpes zoster without any health insurance coverage. S 6.] This act shall take effect on the ninetieth day after it shall have become a law [and shall expire and be deemed repealed July 1, 2015 provided, that: (a) the amendments to subdivision 7 of section 6527 of the education law made by section one of this act shall not affect the repeal of such subdivision and shall be deemed to be repealed therewith; (b) the amendments to subdivision 7 of section 6909 of the education law, made by section two of this act shall not affect the repeal of such subdivision and shall be deemed to be repealed therewith; (c) the amendments to subdivision 22 of section 6802 of the education law made by section three of this act shall not affect the repeal of such subdivision and shall be deemed to be repealed therewith; and (d) the amendments to section 6801 of the education law made by section four of this act shall not affect the expiration of such section and shall be deemed to expire therewith]. S 13. This act shall take effect immediately.

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