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.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6505B
SPONSOR: Crespo (MS) 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 emergen-
cies (Part F); to amend the real property law, in relation to residen-
tial 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 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 500. 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:
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.
