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A08135 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         8135--B
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                      June 9, 2015
                                       ___________
 
        Introduced  by  M.  of  A.  CAHILL,  SEAWRIGHT, ROSENTHAL, GALEF, GLICK,
          JAFFEE,  KAMINSKY,  RUSSELL,  SIMOTAS,  SOLAGES,  GOTTFRIED,   LAVINE,
          BARRON,  BLAKE,  BARRETT, MAGNARELLI -- Multi-Sponsored by -- M. of A.
          ARROYO, BRAUNSTEIN, BRONSON, CLARK, COOK, DUPREY, FAHY, FARRELL, HOOP-
          ER, LIFTON, LUPARDO, MAYER, McLAUGHLIN, MOSLEY, PEOPLES-STOKES, ROZIC,
          SCHIMEL, SIMON, THIELE, TITUS -- (at request of the Department of Law)
          -- read once and referred to the Committee on Insurance -- recommitted
          to the Committee on Insurance in accordance with Assembly Rule 3, sec.
          2 -- committee discharged, bill amended, ordered reprinted as  amended
          and  recommitted to said committee -- again reported from said commit-
          tee with amendments, ordered reprinted as amended and  recommitted  to
          said committee
 
        AN  ACT  to amend the insurance law, the social services law, the educa-
          tion law and the public health law, in relation  to  requiring  health
          insurance  policies to include coverage of all FDA-approved contracep-
          tive drugs, devices, and products, as well as voluntary  sterilization
          procedures, contraceptive education and counseling, and related follow
          up  services  and  prohibiting a health insurance policy from imposing
          any cost-sharing requirements or other  restrictions  or  delays  with
          respect to this coverage
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. This act shall be known and may be cited as the "comprehen-
     2  sive contraception coverage act".
     3    § 2. Paragraph 16 of subsection (l) of section 3221 of  the  insurance
     4  law,  as added by chapter 554 of the laws of 2002, is amended to read as
     5  follows:
     6    (16) (A) Every group or blanket policy [which  provides  coverage  for
     7  prescription  drugs shall include coverage for the cost of contraceptive
     8  drugs or devices approved by the federal food and drug administration or
     9  generic equivalents approved as substitutes by such food and drug admin-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10923-11-6

        A. 8135--B                          2

     1  istration under the prescription  of  a  health  care  provider  legally
     2  authorized  to  prescribe  under  title  eight of the education law. The
     3  coverage required by this section shall  be  included  in  policies  and
     4  certificates only through the addition of a rider.
     5    (A)]  that  is  issued, amended, renewed, effective or delivered on or
     6  after January first, two thousand seventeen, shall provide coverage  for
     7  all of the following services and contraceptive methods:
     8    (1) All FDA-approved contraceptive drugs, devices, and other products.
     9  This  includes  all  FDA-approved  over-the-counter contraceptive drugs,
    10  devices, and products as prescribed or  as  otherwise  authorized  under
    11  state or federal law. The following applies to this coverage:
    12    (a)  where the FDA has approved one or more therapeutic and pharmaceu-
    13  tical equivalent, as defined by the FDA,  versions  of  a  contraceptive
    14  drug,  device,  or product, a group or blanket policy is not required to
    15  include all such therapeutic and pharmaceutical equivalent  versions  in
    16  its  formulary,  so long as at least one is included and covered without
    17  cost-sharing and in accordance with this paragraph;
    18    (b) if the covered therapeutic and pharmaceutical equivalent  versions
    19  of  a drug, device, or product are not available or are deemed medically
    20  inadvisable a group or blanket policy  shall  provide  coverage  for  an
    21  alternate  therapeutic  and  pharmaceutical  equivalent  version  of the
    22  contraceptive drug, device, or product without cost-sharing;
    23    (c) this coverage shall include emergency contraception without  cost-
    24  sharing  when provided pursuant to an ordinary prescription, non-patient
    25  specific regimen order, or order under section sixty-eight hundred thir-
    26  ty-one of the education  law  and  when  lawfully  provided  other  than
    27  through a prescription or order; and
    28    (d) this coverage must allow for the dispensing of twelve months worth
    29  of a contraceptive at one time;
    30    (2) Voluntary sterilization procedures;
    31    (3) Patient education and counseling on contraception; and
    32    (4)  Follow-up  services  related to the drugs, devices, products, and
    33  procedures covered under this paragraph, including, but not limited  to,
    34  management  of  side  effects,  counseling  for continued adherence, and
    35  device insertion and removal.
    36    (B) A group or blanket policy subject  to  this  paragraph  shall  not
    37  impose  a  deductible, coinsurance, copayment, or any other cost-sharing
    38  requirement on the coverage provided pursuant to this paragraph.
    39    (C) Except as otherwise authorized under this paragraph,  a  group  or
    40  blanket policy shall not impose any restrictions or delays on the cover-
    41  age required under this paragraph.
    42    (D)  Benefits  for  an enrollee under this paragraph shall be the same
    43  for an  enrollee's  covered  spouse  or  domestic  partner  and  covered
    44  nonspouse dependents.
    45    (E)  Notwithstanding  any  other provision of this subsection, a reli-
    46  gious employer may request a contract without coverage for federal  food
    47  and drug administration approved contraceptive methods that are contrary
    48  to  the  religious  employer's  religious  tenets. If so requested, such
    49  contract shall be provided without coverage for  contraceptive  methods.
    50  This  paragraph  shall not be construed to deny an enrollee coverage of,
    51  and timely access to, contraceptive methods.
    52    (1) For purposes of this subsection,  a  "religious  employer"  is  an
    53  entity for which each of the following is true:
    54    (a) The inculcation of religious values is the purpose of the entity.
    55    (b)  The  entity  primarily  employs  persons  who share the religious
    56  tenets of the entity.

        A. 8135--B                          3
 
     1    (c) The entity serves primarily persons who share the religious tenets
     2  of the entity.
     3    (d)  The  entity  is  a nonprofit organization as described in Section
     4  6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
     5    (2) Every religious employer that invokes the exemption provided under
     6  this paragraph shall provide written  notice  to  prospective  enrollees
     7  prior to enrollment with the plan, listing the contraceptive health care
     8  services the employer refuses to cover for religious reasons.
     9    [(B)  (i)] (F) (1) Where a group policyholder makes an election not to
    10  purchase coverage for contraceptive drugs or devices in accordance  with
    11  subparagraph  [(A)] (E) of this paragraph each certificateholder covered
    12  under the policy issued to that group policyholder shall have the  right
    13  to  directly  purchase  the  rider  required  by this paragraph from the
    14  insurer which issued the group policy  at  the  prevailing  small  group
    15  community  rate  for such rider whether or not the employee is part of a
    16  small group.
    17    [(ii)] (2) Where  a  group  policyholder  makes  an  election  not  to
    18  purchase  coverage for contraceptive drugs or devices in accordance with
    19  subparagraph [(A)] (E) of this paragraph, the insurer that provides such
    20  coverage shall provide written notice to certificateholders upon enroll-
    21  ment with the insurer of their right to directly purchase  a  rider  for
    22  coverage  for  the  cost  of  contraceptive drugs or devices. The notice
    23  shall also advise the certificateholders of the additional  premium  for
    24  such coverage.
    25    [(C)]  (G) Nothing in this paragraph shall be construed as authorizing
    26  a group or blanket policy which provides coverage for prescription drugs
    27  to exclude coverage for prescription drugs prescribed for reasons  other
    28  than contraceptive purposes.
    29    [(D) Such coverage may be subject to reasonable annual deductibles and
    30  coinsurance  as  may  be deemed appropriate by the superintendent and as
    31  are consistent with those established for other drugs or devices covered
    32  under the policy.]
    33    § 3. Subsection (cc) of section 4303 of the insurance law, as added by
    34  chapter 554 of the laws of 2002, is amended to read as follows:
    35    (cc) (1) Every contract  [which  provides  coverage  for  prescription
    36  drugs  shall  include  coverage  for  the cost of contraceptive drugs or
    37  devices approved by the federal food and drug administration or  generic
    38  equivalents approved as substitutes by such food and drug administration
    39  under  the  prescription of a health care provider legally authorized to
    40  prescribe under title eight of the education law. The coverage  required
    41  by  this  section  shall  be included in contracts and certificates only
    42  through the addition of a rider.
    43    (1)] that is issued, amended, renewed, effective or  delivered  on  or
    44  after  January first, two thousand seventeen, shall provide coverage for
    45  all of the following services and contraceptive methods:
    46    (A) All FDA-approved contraceptive drugs, devices, and other products.
    47  This includes all  FDA-approved  over-the-counter  contraceptive  drugs,
    48  devices,  and  products  as  prescribed or as otherwise authorized under
    49  state or federal law.  The following applies to this coverage:
    50    (i) where the FDA has approved one or more therapeutic and  pharmaceu-
    51  tical  equivalent,  as  defined  by the FDA, versions of a contraceptive
    52  drug, device, or product, a contract is not required to include all such
    53  therapeutic and pharmaceutical equivalent versions in its formulary,  so
    54  long as at least one is included and covered without cost-sharing and in
    55  accordance with this subsection;

        A. 8135--B                          4
 
     1    (ii) if the covered therapeutic and pharmaceutical equivalent versions
     2  of  a drug, device, or product are not available or are deemed medically
     3  inadvisable a contract shall provide coverage for an alternate therapeu-
     4  tic and pharmaceutical equivalent version  of  the  contraceptive  drug,
     5  device, or product without cost-sharing;
     6    (iii)  this  coverage  shall  include  emergency contraception without
     7  cost-sharing when provided pursuant to an ordinary prescription, non-pa-
     8  tient specific regimen order, or order under section sixty-eight hundred
     9  thirty-one of the education law and when lawfully  provided  other  than
    10  through a prescription or order; and
    11    (iv)  this  coverage  must  allow  for the dispensing of twelve months
    12  worth of a contraceptive at one time;
    13    (B) Voluntary sterilization procedures;
    14    (C) Patient education and counseling on contraception; and
    15    (D) Follow-up services related to the drugs,  devices,  products,  and
    16  procedures covered under this subsection, including, but not limited to,
    17  management  of  side  effects,  counseling  for continued adherence, and
    18  device insertion and removal.
    19    (2) A contract subject to this subsection shall not impose  a  deduct-
    20  ible,  coinsurance,  copayment, or any other cost-sharing requirement on
    21  the coverage provided pursuant to this subsection.
    22    (3) Except as otherwise authorized under this subsection,  a  contract
    23  shall  not  impose  any  restrictions or delays on the coverage required
    24  under this subsection.
    25    (4) Benefits for an enrollee under this subsection shall be  the  same
    26  for  an  enrollee's  covered  spouse  or  domestic  partner  and covered
    27  nonspouse dependents.
    28    (5) Notwithstanding any other provision of this  subsection,  a  reli-
    29  gious  employer may request a contract without coverage for federal food
    30  and drug administration approved contraceptive methods that are contrary
    31  to the religious employer's religious  tenets.  If  so  requested,  such
    32  contract  shall  be provided without coverage for contraceptive methods.
    33  This paragraph shall not be construed to deny an enrollee  coverage  of,
    34  and timely access to, contraceptive methods.
    35    (A)  For  purposes  of  this  subsection, a "religious employer" is an
    36  entity for which each of the following is true:
    37    (i) The inculcation of religious values is the purpose of the entity.
    38    (ii) The entity primarily employs  persons  who  share  the  religious
    39  tenets of the entity.
    40    (iii)  The  entity  serves  primarily  persons who share the religious
    41  tenets of the entity.
    42    (iv) The entity is a nonprofit organization as  described  in  Section
    43  6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
    44    (B) Every religious employer that invokes the exemption provided under
    45  this  paragraph  shall  provide  written notice to prospective enrollees
    46  prior to enrollment with the plan, listing the contraceptive health care
    47  services the employer refuses to cover for religious reasons.
    48    [(2)](6) (A) Where a group contractholder makes  an  election  not  to
    49  purchase  coverage for contraceptive drugs or devices in accordance with
    50  paragraph [one] five of this subsection, each enrollee covered under the
    51  contract issued to that group contractholder shall  have  the  right  to
    52  directly purchase the rider required by this subsection from the insurer
    53  or  health  maintenance  organization which issued the group contract at
    54  the prevailing small group community rate for such rider whether or  not
    55  the employee is part of a small group.

        A. 8135--B                          5
 
     1    (B)  Where  a  group  contractholder makes an election not to purchase
     2  coverage for contraceptive drugs or devices in accordance with paragraph
     3  [one] five of this subsection, the insurer or health maintenance  organ-
     4  ization  that  provides  such  coverage  shall provide written notice to
     5  enrollees  upon enrollment with the insurer or health maintenance organ-
     6  ization of their right to directly purchase a rider for coverage for the
     7  cost of contraceptive drugs or devices. The notice shall also advise the
     8  enrollees of the additional premium for such coverage.
     9    [(3)](7) Nothing in this subsection shall be construed as  authorizing
    10  a  contract  which  provides  coverage for prescription drugs to exclude
    11  coverage for  prescription  drugs  prescribed  for  reasons  other  than
    12  contraceptive purposes.
    13    [(4) Such coverage may be subject to reasonable annual deductibles and
    14  coinsurance  as  may  be deemed appropriate by the superintendent and as
    15  are consistent with those established for other drugs or devices covered
    16  under the policy.]
    17    § 4. Subparagraph (E) of paragraph 17 of  subsection  (i)  of  section
    18  3216  of the insurance law is amended by adding a new clause (v) to read
    19  as follows:
    20    (v) all FDA-approved contraceptive drugs, devices, and other products,
    21  including  all  over-the-counter  contraceptive  drugs,   devices,   and
    22  products as prescribed or as otherwise authorized under state or federal
    23  law;  voluntary  sterilization  procedures;  patient education and coun-
    24  seling on contraception; and follow-up services related  to  the  drugs,
    25  devices,  products, and procedures covered under this clause, including,
    26  but not limited to, management of side effects, counseling for continued
    27  adherence, and device insertion and removal. Except as otherwise author-
    28  ized under this clause, a contract shall not impose any restrictions  or
    29  delays  on  the  coverage required under this clause. However, where the
    30  FDA has approved one or more therapeutic and pharmaceutical  equivalent,
    31  as  defined  by  the  FDA,  versions of a contraceptive drug, device, or
    32  product, a contract is not required to include all such therapeutic  and
    33  pharmaceutical equivalent versions in its formulary, so long as at least
    34  one  is included and covered without cost-sharing and in accordance with
    35  this clause. If the covered therapeutic  and  pharmaceutical  equivalent
    36  versions  of  a drug, device, or product are not available or are deemed
    37  medically inadvisable a contract shall provide coverage for an alternate
    38  therapeutic and pharmaceutical equivalent version of  the  contraceptive
    39  drug,  device,  or  product  without  cost-sharing.  This coverage shall
    40  include  emergency  contraception  without  cost-sharing  when  provided
    41  pursuant  to  an  ordinary  prescription,  non-patient  specific regimen
    42  order, or order under section  sixty-eight  hundred  thirty-one  of  the
    43  education   law   and  when  lawfully  provided  other  than  through  a
    44  prescription or order; and this coverage must allow for  the  dispensing
    45  of twelve months worth of a contraceptive at one time.
    46    §  5.  Paragraph  (d)  of subdivision 3 of section 365-a of the social
    47  services law, as amended by chapter 909 of  the  laws  of  1974  and  as
    48  relettered  by  chapter  82  of  the laws of 1995, is amended to read as
    49  follows:
    50    (d) family planning services and twelve months of supplies for  eligi-
    51  ble  persons  of  childbearing  age, including children under twenty-one
    52  years of age who can be considered  sexually  active,  who  desire  such
    53  services  and  supplies,  in accordance with the requirements of federal
    54  law and regulations and the regulations of  the  department.  No  person
    55  shall be compelled or coerced to accept such services or supplies.

        A. 8135--B                          6
 
     1    §  6.  Subdivision 6 of section 6527 of the education law, as added by
     2  chapter 573 of the laws of 1999, paragraph (c) as added by  chapter  221
     3  of  the  laws of 2002, paragraph (d) as added by chapter 429 of the laws
     4  of 2005, paragraph (e) as added by chapter 352 of the laws of  2014  and
     5  paragraph  (f) as added by section 6 of part V of chapter 57 of the laws
     6  of 2015, is amended to read as follows:
     7    6. A licensed physician may prescribe and order a non-patient specific
     8  regimen [to a registered professional nurse],  pursuant  to  regulations
     9  promulgated  by  the commissioner, and consistent with the public health
    10  law, [for] to:
    11    (a) a registered professional nurse for:
    12    (i) administering immunizations[.];
    13    [(b)] (ii) the emergency treatment of anaphylaxis[.];
    14    [(c)] (iii) administering purified protein derivative (PPD) tests[.];
    15    [(d)] (iv) administering tests to determine the presence of the  human
    16  immunodeficiency virus[.];
    17    [(e)] (v) administering tests to determine the presence of the hepati-
    18  tis C virus[.];
    19    [(f)] (vi) emergency contraception, to be administered to or dispensed
    20  to  be  self-administered  by  the  patient,  under  section sixty-eight
    21  hundred thirty-two of this title; or
    22    (vii) the urgent or emergency treatment of opioid related overdose  or
    23  suspected opioid related overdose.
    24    (b)  a licensed pharmacist, for dispensing emergency contraception, to
    25  be self-administered by the patient, under section  sixty-eight  hundred
    26  thirty-two of this title.
    27    § 6-a. Paragraph (c) of subdivision 6 of section 6527 of the education
    28  law,  as  amended by chapter 464 of the laws of 2015, is amended to read
    29  as follows:
    30    [(c)](iii) administering purified protein derivative  (PPD)  tests  or
    31  other tests to detect or screen for tuberculosis infections[.];
    32    §  7.  Subdivision 3 of section 6807 of the education law, as added by
    33  chapter 573 of the laws of 1999, is amended and a new subdivision  4  is
    34  added to read as follows:
    35    3. A pharmacist may dispense drugs and devices to a registered profes-
    36  sional nurse, and a registered professional nurse may possess and admin-
    37  ister,  drugs  and  devices,  pursuant to a non-patient specific regimen
    38  prescribed or ordered by  a  licensed  physician,  licensed  midwife  or
    39  certified nurse practitioner, pursuant to regulations promulgated by the
    40  commissioner and the public health law.
    41    4.  A  pharmacist may dispense a non-patient specific regimen of emer-
    42  gency contraception, to be self-administered by the patient,  prescribed
    43  or  ordered  by  a  licensed physician, certified nurse practitioner, or
    44  licensed midwife, under section sixty-eight hundred thirty-two  of  this
    45  article.
    46    § 8. The education law is amended by adding a new section 6832 to read
    47  as follows:
    48    §  6832. Emergency contraception; non-patient specific prescription or
    49  order. 1. As used in this section, the following terms  shall  have  the
    50  following meanings, unless the context requires otherwise:
    51    (a)  "Emergency  contraception"  means  one  or  more  prescription or
    52  nonprescription drugs, used separately or in combination,  in  a  dosage
    53  and  manner  for preventing pregnancy when used after intercourse, found
    54  safe and effective for that use by  the  United  States  food  and  drug
    55  administration, and dispensed or administered for that purpose.

        A. 8135--B                          7
 
     1    (b)  "Prescriber"  means a licensed physician, certified nurse practi-
     2  tioner or licensed midwife.
     3    2. This section applies to the administering or dispensing of emergen-
     4  cy contraception by a registered professional nurse or the dispensing of
     5  emergency   contraception   by  a  licensed  pharmacist  pursuant  to  a
     6  prescription or order for a non-patient specific regimen made by a pres-
     7  criber under section sixty-five hundred twenty-seven, sixty-nine hundred
     8  nine or sixty-nine hundred fifty-one of this title.  This  section  does
     9  not  apply  to  administering or dispensing emergency contraception when
    10  lawfully done without such a prescription or order.
    11    3. The administering or dispensing of  emergency  contraception  by  a
    12  registered  professional nurse or the dispensing of emergency contracep-
    13  tion by a licensed pharmacist shall be done in accordance  with  profes-
    14  sional  standards  of practice and in accordance with written procedures
    15  and protocols agreed to by the registered professional nurse or licensed
    16  pharmacist and the prescriber or  a  hospital  (licensed  under  article
    17  twenty-eight  of  the  public health law) that provides gynecological or
    18  family planning services.
    19    4. (a) When emergency contraception is administered or dispensed,  the
    20  registered  professional  nurse  or licensed pharmacist shall provide to
    21  the patient written material that includes: (i) the  clinical  consider-
    22  ations  and  recommendations  for  use of the drug; (ii) the appropriate
    23  method for using the  drug;  (iii)  information  on  the  importance  of
    24  follow-up  health  care;  (iv) information on the health risks and other
    25  dangers of unprotected intercourse; and (v) referral information  relat-
    26  ing  to  health  care and services relating to sexual abuse and domestic
    27  violence.
    28    (b) Such written material  shall  be  developed  or  approved  by  the
    29  commissioner in consultation with the department of health and the Amer-
    30  ican college of obstetricians and gynecologists.
    31    §  9.  Subdivision 4 of section 6909 of the education law, as added by
    32  chapter 573 of the laws of 1999, paragraph (a) as amended and  paragraph
    33  (c)  as added by chapter 221 of the laws of 2002, paragraph (d) as added
    34  by chapter 429 of the laws of 2005, paragraph (e) as  added  by  chapter
    35  352  of the laws of 2014 and paragraph (f) as added by section 5 of part
    36  V of chapter 57 of the laws of 2015, is amended to read as follows:
    37    4. A certified nurse practitioner may prescribe and  order  a  non-pa-
    38  tient specific regimen [to a registered professional nurse], pursuant to
    39  regulations promulgated by the commissioner, consistent with subdivision
    40  three  of  section  [six  thousand  nine] sixty-nine hundred two of this
    41  article, and consistent with the public health law, for:
    42    (a) a registered professional nurse for:
    43    (i) administering immunizations[.];
    44    [(b)] (ii) the emergency treatment of anaphylaxis[.];
    45    [(c)] (iii) administering purified protein derivative (PPD) tests[.];
    46    [(d)] (iv) administering tests to determine the presence of the  human
    47  immunodeficiency virus[.];
    48    [(e)] (v) administering tests to determine the presence of the hepati-
    49  tis C virus[.];
    50    [(f)] (vi) emergency contraception, to be administered to or dispensed
    51  to  be  self-administered  by  the  patient,  under  section sixty-eight
    52  hundred thirty-two of this title; or
    53    (vii) the urgent or emergency treatment of opioid related overdose  or
    54  suspected opioid related overdose.

        A. 8135--B                          8
 
     1    (b)  a licensed pharmacist, for dispensing emergency contraception, to
     2  be self-administered by the patient, under section  sixty-eight  hundred
     3  thirty-two of this title.
     4    § 9-a. Paragraph (c) of subdivision 4 of section 6909 of the education
     5  law,  as  amended by chapter 464 of the laws of 2015, is amended to read
     6  as follows:
     7    [(c)](iii) administering purified protein derivative  (PPD)  tests  or
     8  other tests to detect or screen for tuberculosis infections[.];
     9    §  10. Subdivision 5 of section 6909 of the education law, as added by
    10  chapter 573 of the laws of 1999, is amended to read as follows:
    11    5. A registered professional nurse may execute a non-patient  specific
    12  regimen  prescribed or ordered by a licensed physician, licensed midwife
    13  or certified nurse practitioner, pursuant to regulations promulgated  by
    14  the commissioner.
    15    §  11.  Section  6951  of the education law is amended by adding a new
    16  subdivision 4 to read as follows:
    17    4. A licensed midwife may prescribe and order a  non-patient  specific
    18  regimen   pursuant  to  regulations  promulgated  by  the  commissioner,
    19  consistent with this section and the public health law, to:
    20    (a) a registered professional nurse for emergency contraception, to be
    21  administered to or dispensed to be  self-administered  by  the  patient,
    22  under section sixty-eight hundred thirty-two of this title; or
    23    (b)  a licensed pharmacist, for dispensing emergency contraception, to
    24  be self-administered by the patient, under section  sixty-eight  hundred
    25  thirty-two of this title.
    26    § 12. Subdivision 1 of section 207 of the public health law is amended
    27  by adding a new paragraph (m) to read as follows:
    28    (m)  Emergency  contraception, including information about its safety,
    29  efficacy, appropriate use and availability.
    30    § 13. This act shall  take  effect  January  1,  2017;  provided  that
    31  section  six  of  this  act shall take effect January 1, 2018; provided,
    32  however, that if chapter 464 of the laws of 2015 shall  not  have  taken
    33  effect  on  or  before such date then the amendments to paragraph (c) of
    34  subdivision 6 of section 6527 of the education law made by section six-a
    35  of this act shall take effect on the same date and in the same manner as
    36  chapter 464 of the laws of 2015, takes effect; provided,  further,  that
    37  if  chapter  464  of  the laws of 2015 shall not have taken effect on or
    38  before such date then the amendments to paragraph (c) of  subdivision  4
    39  of  section 6909 of the education law made by section nine-a of this act
    40  shall take effect on the same date and in the same manner as chapter 464
    41  of the laws of 2015, takes effect; and provided, further, that effective
    42  immediately, the addition, amendment and/or repeal of any rule or  regu-
    43  lation  necessary  for  the  implementation of this act on its effective
    44  date is authorized and directed to be made and completed by the  commis-
    45  sioner of education and the board of regents on or before such effective
    46  date.
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