|SAME AS||SAME AS S02723|
|Add Art 27-BB §§2725 - 2727, Art 13-l §§1399-xx & 1399-yy, Art 24-F §§2499-b - 2499-d, amd §§2111 & 1399-o-1, Pub Health L; add §§3001-e, 1527-a & 923, Ed L; add §235-h, RP L; amd §33-0303, En Con L; add $144, Pub Bldg L|
|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 areas; 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.|
|02/06/2017||referred to health|
|01/03/2018||referred to health|
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NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5161 SPONSOR: Crespo
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 smoking restrictions in certain outdoor areas (Part E); to amend the education law, in relation to requiring all teachers to be trained in identifying and responding to asthma emergencies (Part F); to amend the real property law, in relation to residential rental prop- erty smoking policies (Part G); 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 H); to amend the education law, in relation to the use of inhalers and nebulizers (Part I); to amend the environmental conserva- tion law, in relation to pesticide alternatives used at schools and day care centers (Part J); and to amend the public buildings law, in relation to curtailing the use of cleaning materials that induce or trigger asthma episodes (Part K)   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 Asth- ma 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-cen- tered 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 informa- tion 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 pregnan- cy programs shall distribute information on the adverse effects of smok- ing 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 develop- mental 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 estab- lish 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 Medi- caid-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) Expands provisions from section 1399-0-1 of the Public health law added by chapter 102 of the laws of 2013 to regulate 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 7: (Part F) 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 emergen- cies. Section 8: (Part G) 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 smok- ing and exposing, particularly children, to such conditions that can trigger asthma attacks and increase the incidence of asthma conditions generally. Section 9: (Part H) 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 individual- ly 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 10: (Part I) Amends Education Law section 923 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 11: (Part J) 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 aria 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 12: (Part K) 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 build- ing 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 arc children and adolescents. Asthma i3 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 educa- tion and treatment of this condition. Asthma is the most common chronic disorder in children and adolescents and is responsible for approximate- ly 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 prob- lem. 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: 2015/2016 - S. 1105 - Referred to Health 2014 - S. 2363 - Referred to Health 2012 - S. 5863 Referred to Health   FISCAL IMPLICATIONS: Some of the provisions of this bill may be subject to fiscal appropri- ation.   EFFECTIVE DATE: See the individual effective dates for each Part of this bill.
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STATE OF NEW YORK ________________________________________________________________________ 5161 2017-2018 Regular Sessions IN ASSEMBLY February 6, 2017 ___________ Introduced by M. of A. CRESPO -- read once and referred 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 smoking restrictions in certain outdoor areas (Part E); to amend the education law, in relation to requiring all teachers to be trained in identifying and responding to asthma emergencies (Part F); to amend the real property law, in relation to residential rental property smoking policies (Part G); 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 H); to amend the education law, in relation to the use of inhalers and nebulizers (Part I); to amend the environmental conservation law, in relation to pesti- cide alternatives used at schools and day care centers (Part J); and to amend the public buildings law, in relation to curtailing the use of cleaning materials that induce or trigger asthma episodes (Part K) The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act enacts into law major components of legislation 2 which combat the incidence of asthma and other respiratory diseases such 3 as emphysema and chronic bronchitis. Each component is wholly contained 4 within a Part identified as Parts A through K. The effective date for 5 each particular provision contained within such Part is set forth in the 6 last section of such Part. Any provision in any section contained within EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08181-01-7A. 5161 2 1 a Part, including the effective date of the Part, which makes a refer- 2 ence to a section "of this act", when used in connection with that 3 particular component, shall be deemed to mean and refer to the corre- 4 sponding section of the Part in which it is found. Section four of this 5 act sets forth the general effective date of this act. 6 § 2. Legislative findings and purpose. The legislature finds that 7 asthma is a chronic, potentially life-threatening, respiratory illness 8 that affects over a million New Yorkers, including thousands of children 9 and adolescents. Asthma is the leading cause of school absences attri- 10 buted to chronic conditions. Asthma is also directly linked to large and 11 growing inpatient bills for medicaid and other health care payers. 12 Therefore, the legislature finds that establishing a comprehensive 13 statewide asthma prevention management and control program which coordi- 14 nates the efforts of individuals, families, health care providers, 15 schools and community-based organizations is in the public interest and 16 would benefit the people of the state of New York. 17 PART A 18 Section 1. The public health law is amended by adding a new article 19 27-BB to read as follows: 20 ARTICLE 27-BB 21 ASTHMA DISEASE MANAGEMENT AND CONTROL 22 Section 2725. Asthma disease management and control program. 23 2726. Study of asthma incidence and prevalence. 24 2727. Annual report. 25 § 2725. Asthma disease management and control program. 1. There is 26 hereby created within the department the asthma disease management and 27 control program (hereinafter referred to in this article as the 28 "program"). The purpose of the program is to promote asthma disease 29 management and education and outreach about asthma to people who suffer 30 from asthma and their families, health care providers, and the general 31 public. 32 2. Services to be provided by the program may include: 33 (a) asthma disease management and case management for patients and 34 their families; 35 (b) asthma outreach and screening; 36 (c) the promotion of awareness of the causes of asthma; 37 (d) education on prevention strategies; 38 (e) education on proper disease management practices; and 39 (f) education on available treatment modalities. 40 3. The commissioner shall make grants within the amounts appropriated 41 therefor to local health agencies, health care providers, schools, 42 school based health centers and community-based organizations, and other 43 organizations with demonstrated interest and expertise in serving 44 persons with asthma to provide the services set out in this section. 45 Grant recipients shall be government entities or not-for-profit organ- 46 izations. 47 The commissioner may coordinate grants under this subdivision with the 48 availability of grants from other sources. The commissioner may also 49 accept or seek grants from other sources to enhance the amounts appro- 50 priated to the program. 51 § 2726. Study of asthma incidence and prevalence. 1. The department 52 shall study the incidence and prevalence of asthma in the state's popu- 53 lation and current disease management practices. Such study shallA. 5161 3 1 utilize information obtained pursuant to article twenty-four-F of this 2 chapter, and include: 3 (a) the cause and nature of the disease; 4 (b) behavioral and environmental triggers; 5 (c) an assessment of the need for patient-centered case management to 6 meet specific physical and environmental needs of patients; 7 (d) outcome evaluations, including, but not limited to, patient 8 perceptions of improvement, signs and symptoms of asthma, pulmonary 9 function, history of asthma exacerbations, pharmacotherapy, assessment 10 of hospital emergency room visits for asthma, and patient-provider 11 communication; and 12 (e) an assessment of the ability of providers, including non-profes- 13 sionals and health care professionals such as physicians, nurses, phar- 14 macists and respiratory therapists, to systemically instruct and develop 15 asthma management plans for patients and frequently review with patients 16 and their families how to manage and control their asthma. 17 2. The department shall gather data for monitoring the occurrence, 18 frequency, incidence, cause, effect and severity of asthma. 19 (a) The department may require the following to report data under this 20 subdivision: 21 i. the statewide planning and research cooperative system (SPARCS); 22 ii. health maintenance organizations licensed pursuant to article 23 forty-three of the insurance law or certified pursuant to this chapter 24 or an independent practice association certified or recognized pursuant 25 to this chapter; 26 iii. other insurers; 27 iv. the Medicaid (title XIX of the federal social security act) 28 program; 29 v. health facilities; 30 vi. health care practitioners; 31 vii. patients: self reporting; 32 viii. the department of environmental conservation; and 33 ix. any other source the commissioner deems appropriate. 34 (b) The department shall compile and analyze data gathered under para- 35 graph (a) of this subdivision and article twenty-four-F of this chapter, 36 and correlate it with data as to places of employment, areas of resi- 37 dence, schools attended, ages of those afflicted, environmental factors 38 including proximity to source of pollution and such other data as the 39 department deems appropriate. 40 (c) The department shall maintain and compile reported data in a 41 manner suitable for research purposes and shall collect and make such 42 data available to persons in the manner set forth in subdivision three 43 of this section. 44 3. Any data collected or reported shall not contain the name of any 45 patient, his or her social security number, or any other information 46 which would permit a patient to be identified. The department shall 47 develop a unique, confidential identifier to be used in the collection 48 of patient information as required by this section. 49 § 2727. Annual report. On or before the first of January during the 50 two calendar years next succeeding the effective date of this section 51 and biennially thereafter, the commissioner shall submit a report 52 regarding the status and accomplishments of the program and provide 53 recommendations to the governor, the temporary president and the minori- 54 ty leader of the senate, and the speaker and the minority leader of the 55 assembly. Such report may be submitted in conjunction with the report 56 required by article twenty-four-F of this chapter.A. 5161 4 1 § 2. This act shall take effect on the one hundred eightieth day after 2 it shall have become a law. Effective immediately the commissioner of 3 health is authorized to promulgate any and all rules and regulations and 4 take any other measures necessary to implement the provisions of this 5 act on its effective date. 6 PART B 7 Section 1. The public health law is amended by adding a new article 8 13-I to read as follows: 9 ARTICLE 13-I 10 IN-UTERO EXPOSURE TO TOBACCO SMOKE PREVENTION 11 Section 1399-xx. In-utero exposure prevention. 12 1399-yy. Programs. 13 § 1399-xx. In-utero exposure prevention. 1. Every healthcare provider, 14 healthcare insurer and pregnancy program shall distribute information on 15 the adverse effects of smoking during pregnancy for both firsthand and 16 secondhand smoke. Such adverse effects to the infant include lower birth 17 rates, higher incidence of asthma and obesity, and cognitive and devel- 18 opmental damage. 19 2. Every healthcare provider shall monitor expectant mothers' smoking 20 statuses and offer continuous tailored discussion of quitting smoking 21 with expectant mothers during their prenatal care. 22 § 1399-yy. Programs. The following programs shall be added to existing 23 tobacco control programs for pregnant women or to other pregnancy 24 related programs: 25 1. Carbon monoxide monitoring; 26 2. Depression, social support and domestic violence screening and 27 referrals; 28 3. Referrals for smoking cessation for household members; 29 4. Ongoing support by counseling and educational materials; and 30 5. Financial incentives such as shipping voucher or diaper coupons for 31 quitting for more than four weeks. 32 § 2. This act shall take effect on the one hundred eightieth day after 33 it shall have become a law. Provided, that effective immediately the 34 commissioner of health is authorized and directed to promulgate any and 35 all rules and regulations, and take any other measures necessary to 36 implement the provisions of this act on its effective date. 37 PART C 38 Section 1. The public health law is amended by adding a new article 39 24-F to read as follows: 40 ARTICLE 24-F 41 ASTHMA REPORTING 42 Section 2499-b. Asthma; duty to report. 43 2499-c. Reporting. 44 2499-d. Asthma; reports confidential. 45 § 2499-b. Asthma; duty to report. 1. Every physician and other health 46 care provider shall give notice to the department within thirty days of 47 every incident of an asthma attack coming under his or her care, except 48 as otherwise provided. 49 2. The person in charge of every asthma reporting facility shall give 50 notice to the department within thirty days of every incident of an 51 asthma attack coming under the care of such facility.A. 5161 5 1 3. The department shall establish regulations designating which 2 specific information shall be reported to the department pursuant to 3 this section. 4 4. A physician or health care provider or asthma reporting facility 5 which violates any provision of this section shall be subject to a civil 6 penalty pursuant to section twelve of this chapter. 7 5. The notices required by this section shall be upon forms supplied 8 by the commissioner and shall contain such information as shall be 9 required by the commissioner. 10 6. For the purposes of this section, an "asthma reporting facility" 11 means a hospital as defined in article twenty-eight of this chapter, 12 clinic, any organization certified pursuant to article forty-four of 13 this chapter, or other similar public or private institution. 14 § 2499-c. Reporting. 1. The commissioner shall submit biennial reports 15 to the governor, the temporary president of the senate, the speaker of 16 the assembly, the minority leader of the senate and the minority leader 17 of the assembly. The reports shall include an evaluation of the asthma 18 registry as it relates to timeliness, quality and completeness; an eval- 19 uation of the utility of the registry for scientific research; an evalu- 20 ation of the access, timeliness and quality of reporting information to 21 researchers and other similar individuals; an evaluation of the regis- 22 try's data elements, including treatment, severity of disease, occupa- 23 tion, age and residence; an evaluation of the feasibility and utility of 24 inclusion of occupational history and residence history; and an evalu- 25 ation of integrating the registry with other databases maintained by 26 state agencies and departments, including the statewide planning and 27 research cooperative system. 28 2. The commissioner shall submit an annual report to the governor, the 29 temporary president of the senate, the speaker of the assembly, the 30 minority leader of the senate and the minority leader of the assembly. 31 Such report shall include an evaluation of whether the registry is 32 achieving asthma incidence registry goals established by a nationally 33 recognized asthma registry organization, including numerical goals 34 concerning timeliness, quality, and completeness. 35 § 2499-d. Asthma; reports confidential. The reports of asthma attacks 36 made pursuant to the provisions of this article shall not be divulged or 37 made public by any person so as to disclose the identity of any person 38 to whom they relate, except in so far as may be authorized in the sani- 39 tary code. 40 § 2. This act shall take effect on the one hundred eightieth day after 41 it shall have become a law. Effective immediately, the commissioner of 42 health is authorized to promulgate any and all rules and regulations and 43 take any other measures necessary to implement this act on its effective 44 date on or before such date. 45 PART D 46 Section 1. Subdivisions 2 and 4 of section 2111 of the public health 47 law, as added by section 21 of part C of chapter 58 of the laws of 2004, 48 are amended to read as follows: 49 2. The department shall establish the criteria by which individuals 50 will be identified as eligible for enrollment in the demonstration 51 programs. Persons eligible for enrollment in the disease management 52 demonstration program shall be limited to individuals who: receive 53 medical assistance pursuant to title eleven of article five of the 54 social services law and may be eligible for benefits pursuant to titleA. 5161 6 1 18 of the social security act (Medicare); are not enrolled in a Medicaid 2 managed care plan, including individuals who are not required or not 3 eligible to participate in Medicaid managed care programs pursuant to 4 section three hundred sixty-four-j of the social services law; are diag- 5 nosed with chronic health problems as may be specified by the entity 6 undertaking the demonstration program, including, but not limited to one 7 or more of the following: congestive heart failure, chronic obstructive 8 pulmonary disease, asthma, emphysema, chronic bronchitis, other respir- 9 atory diseases, diabetes or other chronic health conditions as may be 10 specified by the department; or have experienced or are likely to expe- 11 rience one or more hospitalizations or are otherwise expected to incur 12 excessive costs and high utilization of health care services. 13 4. The demonstration program shall offer evidence-based services and 14 interventions designed to ensure that the enrollees receive high quali- 15 ty, preventative and cost-effective care, aimed at reducing the necessi- 16 ty for hospitalization or emergency room care or at reducing lengths of 17 stay when hospitalization is necessary. The demonstration program may 18 include screening of eligible enrollees, developing an individualized 19 care management plan for each enrollee and implementing that plan. 20 Disease management demonstration programs that utilize information tech- 21 nology systems that allow for continuous application of evidence-based 22 guidelines to medical assistance claims data and other available data to 23 identify specific instances in which clinical interventions are justi- 24 fied and communicate indicated interventions to physicians, health care 25 providers and/or patients, and monitor physician and health care provid- 26 er response to such interventions, shall have the enrollees, or groups 27 of enrollees, approved by the department for participation. The services 28 provided by the demonstration program as part of the care management 29 plan may include, but are not limited to, case management, social work, 30 individualized health counselors, multi-behavioral goals plans, claims 31 data management, health and self-care education, drug therapy management 32 and oversight, personal emergency response systems and other monitoring 33 technologies, systematic chronic health conditions identified for moni- 34 toring, telehealth services and similar services designed to improve the 35 quality and cost-effectiveness of health care services. 36 § 2. This act shall take effect immediately. 37 PART E 38 Section 1. Legislative intent. The legislature recognizes that expo- 39 sure to second-hand smoke is known to cause cancer, pneumonia, asthma, 40 bronchitis and heart disease in humans, and to trigger asthma attacks. 41 The legislature finds that prohibiting smoking within a presumptively 42 reasonable minimum distance of fifteen feet from entrances and exits 43 that serve enclosed areas where smoking is prohibited is consistent with 44 such prohibition. This legislation will apply to any individual occupy- 45 ing such area with the purpose of smoking, but provides exceptions for 46 individuals passing through such area. Therefore, the legislature finds 47 that smoking in such area shall be prohibited and owners and other indi- 48 viduals in control of such area are recommended to post signs indicating 49 no smoking areas and providing for fines for violations. 50 § 2. Section 1399-o-1 of the public health law, as added by chapter 51 102 of the laws of 2013, is amended to read as follows: 52 § 1399-o-1. Smoking restrictions; certain outdoor areas. 1. a. Smok- 53 ing shall not be permitted and no person shall smoke during the hours 54 between sunrise and sunset, when one or more persons under the age ofA. 5161 7 1 twelve are present at any playground. For the purposes of this [ section] 2 subdivision, the term "playground" means an improved area designed, 3 equipped, and set aside for play of six or more children which is not 4 intended for use as an athletic playing field or athletic court, and 5 shall include any play equipment, surfacing, fencing, signs, internal 6 pathways, internal land forms, vegetation, and related structures. Play- 7 grounds or playground equipment constructed upon one, two and three-fa- 8 mily residential real property are exempt from the requirements of this 9 [ section] subdivision. This [ section] subdivision shall not apply to 10 any playground located within the city of New York. 11 [ 2.] b. No police officer, peace officer, regulatory officer or law 12 enforcement official may arrest, ticket, stop or question any person 13 based solely or in part on an alleged violation of paragraph a of this 14 subdivision [ one of this section], nor may an alleged violation of para- 15 graph a of this subdivision [ one of this section] support probable cause 16 to conduct any search or limited search of any person or his or her 17 immediate surroundings. 18 2. a. Smoking is prohibited within a presumptively reasonable minimum 19 distance of fifteen feet from entrances or exits of public buildings or 20 private buildings that contain state or municipal offices or educational 21 facilities for elementary or secondary school students. Such distance 22 shall become a designated no smoking zone. 23 b. Local health departments are authorized to adopt regulations as are 24 required to implement this subdivision. Any penalty assessed and recov- 25 ered in an action brought under this subdivision shall be paid to and 26 used by the municipality bringing the action. 27 c. This subdivision shall not apply to individuals walking through the 28 designated no smoking zone of such area for the purpose of getting to 29 another destination, but shall only apply to individuals occupying the 30 designated no smoking zone for the purpose of smoking. 31 d. Any person violating the provisions of this subdivision shall be 32 guilty of a violation, and is subject to a fine of thirty-five dollars. 33 e. The commissioner may recommend designs for signs which may be used 34 by the owners, operators, managers, employers or other persons, at their 35 option, who control areas where smoking is prohibited pursuant to 36 section thirteen hundred ninety-nine-o of this article. Such signs shall 37 include the warning that "smoking in this area is punishable by law and 38 all violators shall be subject to a fine of thirty-five dollars." 39 f. Nothing contained in this subdivision is intended to regulate smok- 40 ing in a private residence or in the general public outdoors, excepting 41 places in which smoking is prohibited through the local fire department, 42 or by other law, ordinance or regulation. 43 § 3. This act shall take effect on the one hundred twentieth day after 44 it shall have become a law. 45 PART F 46 Section 1. The education law is amended by adding a new section 3001-e 47 to read as follows: 48 § 3001-e. Asthma emergencies; training in identification and response. 49 The commissioner, in consultation with the commissioner of health, shall 50 establish standards for the training of teachers and other appropriate 51 personnel in identifying and responding to asthma emergencies in pupils 52 and other persons. Such standards shall specify minimum levels of know- 53 ledge and procedures to be followed. Such standards shall permit train-A. 5161 8 1 ing to be given by persons or organizations deemed qualified to do so by 2 the commissioner. 3 § 2. This act shall take effect one year after it shall have become a 4 law. 5 PART G 6 Section 1. The real property law is amended by adding a new section 7 235-h to read as follows: 8 § 235-h. Residential rental property smoking policies. Every rental 9 agreement for a dwelling unit, in a multiple dwelling building with four 10 or more units, shall include a disclosure of the smoking policy for the 11 premises on which the dwelling unit is located. The disclosure must 12 state whether smoking is prohibited on the premises, allowed on the 13 entire premises or allowed in limited areas on the premises. If the 14 smoking policy allows smoking in limited areas on the premises, the 15 disclosure must identify the areas on the premises where smoking is 16 allowed. 17 § 2. This act shall take effect on the first of January next succeed- 18 ing the date on which it shall have become a law. 19 PART H 20 Section 1. The education law is amended by adding a new section 1527-a 21 to read as follows: 22 § 1527-a. Idling motor vehicles on school grounds. 1. On or before 23 September first, two thousand nineteen and consistent with the commis- 24 sioner's regulations, adopted pursuant to section thirty-six hundred 25 thirty-seven of this chapter, the board of education or board of trus- 26 tees of every school district and the governing body of every private 27 elementary or secondary school in the state shall promulgate and imple- 28 ment rules prohibiting the engine of any motor vehicle, as defined in 29 section one hundred twenty-five of the vehicle and traffic law, to 30 remain idling for more than one minute while such vehicle is parked or 31 standing on school grounds, adjacent to school grounds, or in front of 32 any school while loading or off loading passengers. 33 2. Each school district and private elementary and secondary school 34 shall conspicuously post signs upon, adjacent and in front of school 35 grounds advising operators of motor vehicles of the provisions of the 36 rules adopted pursuant to subdivision one of this section. 37 § 2. This act shall take effect immediately. 38 PART I 39 Section 1. The education law is amended by adding a new section 923 40 to read as follows: 41 § 923. Use of nebulizer. 1. Every school district and board of cooper- 42 ative educational services in this state may maintain one or more nebu- 43 lizers in the office of the school nurse or in a similar accessible 44 location. 45 2. The commissioner, in consultation with the commissioner of health, 46 may promulgate regulations for the administration of asthma medication 47 through the use of a nebulizer by the school nurse or person authorized 48 by regulation. The regulations may include: 49 a. a requirement that each certified nurse or other person authorized 50 to administer asthma medication in schools receive training in airwayA. 5161 9 1 management and in the use of nebulizers and inhalers consistent with 2 nationally recognized standards; and 3 b. a requirement that each pupil authorized to use asthma medication 4 pursuant to subdivision one of section nine hundred sixteen of this 5 article or a nebulizer have an asthma treatment plan prepared by the 6 physician of the pupil, which identify, at a minimum, asthma triggers, 7 the treatment plan, and such other elements as shall be determined by 8 the regents. 9 § 2. This act shall take effect on the one hundred eightieth day after 10 it shall have become a law; provided, however, that effective immediate- 11 ly the commissioner of education is authorized to promulgate rules and 12 regulations for the implementation of this act on such effective date. 13 PART J 14 Section 1. Subdivision 7 of section 33-0303 of the environmental 15 conservation law, as added by chapter 85 of the laws of 2010, is amended 16 to read as follows: 17 7. The commissioner, in consultation with the commissioner of educa- 18 tion and the commissioner of health, shall develop guidance and regu- 19 lations on pesticide alternatives to facilitate compliance with section 20 four hundred nine-k of the education law and three hundred ninety-g of 21 the social services law. Provided, further, that such pesticide alterna- 22 tives shall help to minimize the incidence of asthma attacks in public 23 and private buildings and residences, while still effectively control- 24 ling the targeted pest or organism. Such regulations shall provide for 25 the use of the least toxic pesticide or pesticides, which effectively 26 eradicates the targeted pest or organism. 27 § 2. This act shall take effect immediately. 28 PART K 29 Section 1. The public buildings law is amended by adding a new 30 section 144 to read as follows: 31 § 144. Curtail use of chemicals that induce or trigger asthma attacks. 32 1. Notwithstanding any other provision of law to the contrary, the 33 superintendent of every state public building, and of every transporta- 34 tion facility operated by a public authority, public benefit corporation 35 or municipality shall to the best of his or her ability curtail the use 36 of cleaning materials or chemicals, exposure to which may cause either 37 the building cleaning staff or other persons who enter such building to 38 develop the disease of asthma, or which may exacerbate or trigger an 39 asthma attack. 40 2. A determination of which or the quantity or concentration of such 41 cleaning materials or chemicals exposure to which may cause persons to 42 develop the disease of asthma, or which may exacerbate or trigger an 43 asthma attack, shall be made by the commissioner of health who shall 44 promulgate a list of such cleaning materials or chemicals. 45 § 2. This act shall take effect on the one hundred eightieth day after 46 it shall have become a law. 47 § 3. Severability clause. If any clause, sentence, paragraph, subdi- 48 vision, section or part of this act shall be adjudged by any court of 49 competent jurisdiction to be invalid, such judgment shall not affect, 50 impair, or invalidate the remainder thereof, but shall be confined in 51 its operation to the clause, sentence, paragraph, subdivision, section 52 or part thereof directly involved in the controversy in which such judg-A. 5161 10 1 ment shall have been rendered. It is hereby declared to be the intent of 2 the legislature that this act would have been enacted even if such 3 invalid provisions had not been included herein. 4 § 4. This act shall take effect immediately provided, however, that 5 the applicable effective date of Parts A through K of this act shall be 6 as specifically set forth in the last section of such Parts.