Bill Text: NY A00342 | 2011-2012 | General Assembly | Introduced


Bill Title: Establishes a healthcare reinvestment fund suburban demonstration project; defines terms; creates an oversight committee; provides for distribution of funds and calculation of reinvestment fund payments; makes related changes.

Sponsorship: Moderate Partisan Bill (Democrat 4-1)

Status: (Introduced - Dead) 2012-02-06 - print number 342a [A00342 Detail]

Download: New_York-2011-A00342-Introduced.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                          342
                              2011-2012 Regular Sessions
                                 I N  A S S E M B L Y
                                      (PREFILED)
                                    January 5, 2011
                                      ___________
       Introduced  by  M.  of A. PAULIN, GALEF, LATIMER, PRETLOW, SPANO -- read
         once and referred to the Committee on Health
       AN ACT to amend the public health law, in  relation  to  establishing  a
         healthcare reinvestment fund suburban demonstration project
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Statement of legislative intent. The legislature finds that
    2  hospitals in the suburbs of New York city face challenges that result in
    3  a significant competitive disadvantage when compared to nearby hospitals
    4  in New Jersey and Connecticut. In particular,  reimbursement  rates  for
    5  these  New  York  state  suburban  hospitals are significantly lower. In
    6  addition, while hospitals in the suburbs of New York city are struggling
    7  financially, in general the for-profit health insurers and health  main-
    8  tenance organizations operating in the suburban area incur profits.
    9    The  legislature  finds  that  there needs to be a balance between the
   10  financial health of hospitals and that of for-profit health insurers and
   11  health maintenance organizations. While the state of New York is invest-
   12  ing in the health care infrastructure of New York state in an amount  of
   13  two  hundred  fifty  million  dollars  a year for four years through the
   14  health care efficiency and affordability law of  New  Yorkers  (HEAL-NY)
   15  capital  grant  program, health insurers should likewise provide invest-
   16  ment in the health care infrastructure of communities,  particularly  in
   17  the  area  of  health  information  technology as health insurers are an
   18  immediate benefactor of health information technology. Strengthening the
   19  financial health of the suburban hospitals will also improve quality  of
   20  care and help retain and attract businesses.
   21    The  legislature finds that requiring for-profit insurers and for-pro-
   22  fit health maintenance organizations to provide funds  for  reinvestment
   23  in  health  information  technology in the suburban area around New York
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02768-01-1
       A. 342                              2
    1  city will provide a benefit to payors,  patients,  hospitals  and  busi-
    2  nesses.
    3    S  2.  The public health law is amended by adding a new section 2807-z
    4  to read as follows:
    5    S 2807-Z. HEALTHCARE REINVESTMENT FUND SUBURBAN DEMONSTRATION PROJECT.
    6  1. DEFINITIONS. FOR THE PURPOSES OF THIS SECTION,  THE  FOLLOWING  TERMS
    7  SHALL HAVE THE FOLLOWING MEANINGS:
    8    (A)  "DEMONSTRATION  PROJECT"  SHALL  MEAN THE HEALTHCARE REINVESTMENT
    9  FUND  SUBURBAN  DEMONSTRATION  PROJECT  ESTABLISHED  PURSUANT  TO   THIS
   10  SECTION.
   11    (B)  "DESIGNATED  THIRD-PARTY  PAYORS" SHALL MEAN FOR-PROFIT ORGANIZA-
   12  TIONS OPERATING IN ACCORDANCE WITH ARTICLE FORTY-FOUR OF  THIS  CHAPTER,
   13  AND FOR-PROFIT COMMERCIAL INSURERS LICENSED TO DO BUSINESS IN THIS STATE
   14  AND AUTHORIZED TO WRITE ACCIDENT AND HEALTH INSURANCE AND WHOSE POLICIES
   15  PROVIDE  COVERAGE  ON  AN EXPENSE INCURRED BASIS. DESIGNATED THIRD PARTY
   16  PAYORS SHALL NOT INCLUDE SELF-INSURED FUNDS AND ADMINISTRATORS ACTING ON
   17  BEHALF OF SELF-INSURED FUNDS,  GOVERNMENTAL  AGENCIES  OR  PROVIDERS  OF
   18  COVERAGE  PURSUANT  TO  THE COMPREHENSIVE MOTOR VEHICLE REPARATIONS ACT,
   19  THE WORKERS' COMPENSATION LAW, THE VOLUNTEER FIREFIGHTERS' BENEFIT  LAW,
   20  OR THE VOLUNTEER AMBULANCE WORKERS' BENEFIT LAW.
   21    (C)  "FAMILY  UNIT"  SHALL HAVE THE SAME MEANING AS SET FORTH IN PARA-
   22  GRAPH (B) OF SUBDIVISION ONE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-T  OF
   23  THIS ARTICLE.
   24    (D) "INDIVIDUAL" SHALL HAVE THE SAME MEANING AS SET FORTH IN PARAGRAPH
   25  (A)  OF  SUBDIVISION ONE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-T OF THIS
   26  ARTICLE.
   27    (E) "REGIONAL HOSPITAL ASSOCIATIONS" SHALL MEAN THE REGIONAL  HOSPITAL
   28  ASSOCIATION  WITH  THE  MAJORITY  OF  ITS  MEMBERS LOCATED IN NASSAU AND
   29  SUFFOLK COUNTIES AND THE REGIONAL HOSPITAL ASSOCIATION WITH THE MAJORITY
   30  OF ITS MEMBERS  LOCATED  IN  WESTCHESTER,  ROCKLAND,  PUTNAM,  DUTCHESS,
   31  ORANGE, ULSTER AND SULLIVAN COUNTIES.
   32    (F)  "REINVESTMENT  FUNDS"  SHALL MEAN THE FUNDS AVAILABLE PURSUANT TO
   33  THE DEMONSTRATION PROJECT.
   34    (G) "SUBURBAN REGION" SHALL MEAN  THE  COUNTIES  OF  NASSAU,  SUFFOLK,
   35  WESTCHESTER, ROCKLAND, PUTNAM, DUTCHESS, ORANGE, ULSTER AND SULLIVAN.
   36    2.  HEALTHCARE  REINVESTMENT  FUND  SUBURBAN  DEMONSTRATION PROJECT. A
   37  HEALTHCARE REINVESTMENT FUND SUBURBAN  DEMONSTRATION  PROJECT  EFFECTIVE
   38  JULY  FIRST,  TWO  THOUSAND  ELEVEN THROUGH JUNE THIRTIETH, TWO THOUSAND
   39  FIFTEEN, TO FUND THE INFORMATION TECHNOLOGY NEEDS OF  GENERAL  HOSPITALS
   40  LOCATED IN THE SUBURBAN REGION SHALL BE ESTABLISHED BY THE COMMISSIONER.
   41  A  TOTAL  OF SIXTY-SEVEN MILLION DOLLARS FROM THE FUNDS ACCUMULATED FROM
   42  THE PAYMENTS MADE IN ACCORDANCE WITH SUBDIVISION SEVEN OF  THIS  SECTION
   43  SHALL  BE  PROVIDED  ANNUALLY DURING THE PERIOD JULY FIRST, TWO THOUSAND
   44  ELEVEN THROUGH JUNE THIRTIETH, TWO THOUSAND FIFTEEN, TO FUND THE  DEMON-
   45  STRATION PROJECT.
   46    3.    HEALTHCARE  REINVESTMENT  FUND OVERSIGHT COMMITTEE. A HEALTHCARE
   47  REINVESTMENT  FUND  OVERSIGHT  COMMITTEE  OF  TWELVE  MEMBERS  SHALL  BE
   48  APPOINTED TO OVERSEE THE DISTRIBUTION OF REINVESTMENT FUNDS. SIX MEMBERS
   49  SHALL  BE  APPOINTED BY EACH OF THE REGIONAL HOSPITAL ASSOCIATIONS. FOUR
   50  MEMBERS SHALL REPRESENT GENERAL HOSPITALS, FOUR MEMBERS SHALL  REPRESENT
   51  DESIGNATED THIRD-PARTY PAYORS AND FOUR MEMBERS SHALL REPRESENT THE BUSI-
   52  NESS COMMUNITY. THE HEALTHCARE REINVESTMENT OVERSIGHT COMMITTEE SHALL:
   53    (A)  MAKE  RECOMMENDATIONS ON USES OF THE REINVESTMENT FUNDS THAT WILL
   54  RESULT IN IMPROVED SHARING OF CLINICAL INFORMATION IN A  COST  EFFECTIVE
   55  MANNER  AMONG  (I) GENERAL HOSPITALS AND PHYSICIANS, (II) GENERAL HOSPI-
       A. 342                              3
    1  TALS AND OTHER PROVIDERS INCLUDING OTHER GENERAL  HOSPITALS,  AND  (III)
    2  GENERAL HOSPITALS AND PAYORS;
    3    (B)  DEVELOP  A PROCESS TO ENSURE THAT GENERAL HOSPITALS USE THE REIN-
    4  VESTMENT FUNDS IN ACCORDANCE WITH THE RECOMMENDATIONS MADE  PURSUANT  TO
    5  PARAGRAPH (A) OF THIS SUBDIVISION; AND
    6    (C)  PROVIDE  A REPORT TO THE COMMISSIONER ON OR BEFORE JANUARY FIRST,
    7  TWO THOUSAND FIFTEEN, EVALUATING WHETHER THE DEMONSTRATION  PROJECT  HAS
    8  ACHIEVED  THE GOAL OF IMPROVING THE SHARING OF CLINICAL INFORMATION IN A
    9  COST EFFECTIVE MANNER, AND MAKING RECOMMENDATIONS ON WHETHER THE  DEMON-
   10  STRATION  PROJECT  SHOULD  BE CONTINUED AND ON POTENTIAL IMPROVEMENTS TO
   11  THE DEMONSTRATION PROJECT.
   12    4. DISTRIBUTION OF REINVESTMENT FUNDS.  THE REINVESTMENT  FUNDS  SHALL
   13  BE  DISTRIBUTED  TO EACH GENERAL HOSPITAL LOCATED IN THE SUBURBAN REGION
   14  PROPORTIONALLY BASED  ON  EACH  GENERAL  HOSPITAL'S  REPORTED  INPATIENT
   15  DISCHARGES  TO  THE  TOTAL  OF SUCH INPATIENT DISCHARGES FOR ALL GENERAL
   16  HOSPITALS LOCATED IN THE SUBURBAN REGION.   FOR THE PERIOD  JULY  FIRST,
   17  TWO  THOUSAND  ELEVEN THROUGH JUNE THIRTIETH, TWO THOUSAND THIRTEEN, THE
   18  DISTRIBUTIONS SHALL BE BASED ON DISCHARGES REPORTED THROUGH  THE  STATE-
   19  WIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM FOR TWO THOUSAND NINE, AND
   20  FOR THE PERIOD JULY FIRST, TWO THOUSAND THIRTEEN THROUGH JUNE THIRTIETH,
   21  TWO  THOUSAND  FIFTEEN,  THE  DISTRIBUTIONS SHALL BE BASED ON DISCHARGES
   22  REPORTED THROUGH THE STATEWIDE PLANNING AND RESEARCH COOPERATIVE  SYSTEM
   23  FOR TWO THOUSAND ELEVEN.
   24    5.  COLLECTION  OF  FUNDS.    THE COMMISSIONER SHALL CONTRACT WITH THE
   25  REGIONAL ASSOCIATIONS TO COLLECT AND DISTRIBUTE  FUNDS  FOR  THE  DEMON-
   26  STRATION PROJECT IN ACCORDANCE WITH THIS SECTION.
   27    6.  CALCULATION OF REINVESTMENT FUND PAYMENTS. (A) BASED ON THE NUMBER
   28  OF INDIVIDUALS AND THE NUMBER OF FAMILY UNITS REPORTED  TO  THE  COMMIS-
   29  SIONER  OR  THE  COMMISSIONER'S DESIGNEE PURSUANT TO SUBDIVISION FOUR OF
   30  SECTION TWENTY-EIGHT HUNDRED SEVEN-T OF THIS ARTICLE,  THE  COMMISSIONER
   31  SHALL  CALCULATE  THE TOTAL NUMBER OF "INDIVIDUAL MEMBER MONTHS" FOR THE
   32  SUBURBAN REGION FOR  ALL  DESIGNATED  THIRD-PARTY  PAYORS  TO  DETERMINE
   33  "AGGREGATE  INDIVIDUAL  MEMBER  MONTHS"  FOR  THE SUBURBAN REGION.   THE
   34  COMMISSIONER SHALL ALSO CALCULATE THE TOTAL  NUMBER  OF  "FAMILY  MEMBER
   35  MONTHS" FOR THE SUBURBAN REGION FOR ALL DESIGNATED THIRD-PARTY PAYORS TO
   36  DETERMINE  THE "AGGREGATE FAMILY MEMBER MONTHS" FOR THE SUBURBAN REGION.
   37  THE COMMISSIONER SHALL MULTIPLY THE AVERAGE NUMBER  OF  PERSONS  COVERED
   38  UNDER FAMILY INSURANCE CONTRACTS, AS REPORTED TO THE COMMISSIONER BY THE
   39  SUPERINTENDENT  OF  INSURANCE  PURSUANT  TO  SUBDIVISION FOUR OF SECTION
   40  TWENTY-EIGHT HUNDRED SEVEN-T OF THIS ARTICLE BY  THE  "AGGREGATE  FAMILY
   41  MEMBER  MONTHS"  TO  DETERMINE "ADJUSTED AGGREGATE FAMILY MEMBER MONTHS"
   42  FOR THE SUBURBAN REGION.   THE COMMISSIONER  SHALL  ADD  THE  NUMBER  OF
   43  "ADJUSTED  FAMILY  MEMBER  MONTHS"  FOR THE SUBURBAN REGION TO THE TOTAL
   44  NUMBER OF "AGGREGATE INDIVIDUAL MEMBER MONTHS" FOR THE SUBURBAN  REGION.
   45  THIS  AMOUNT  SHALL  BE  KNOWN  AS "TOTAL COVERED MEMBER MONTHS" FOR THE
   46  SUBURBAN REGION.
   47    (B) AN ANNUAL AMOUNT OF SIXTY-SEVEN MILLION DOLLARS SHALL  BE  DIVIDED
   48  BY  AN  ESTIMATE DERIVED FROM POPULATION BASED DATA SOURCES OF THE TOTAL
   49  COVERED MEMBER MONTHS DETERMINED CONSISTENT WITH THE PROVISIONS OF PARA-
   50  GRAPH (A) OF THIS SUBDIVISION IN THE SUBURBAN REGION  TO  ESTABLISH  THE
   51  "INDIVIDUAL  ANNUAL  PAYMENT AMOUNT" FOR JULY FIRST, TWO THOUSAND ELEVEN
   52  THROUGH JUNE THIRTIETH, TWO THOUSAND TWELVE; JULY  FIRST,  TWO  THOUSAND
   53  TWELVE  THROUGH  JUNE  THIRTIETH, TWO THOUSAND THIRTEEN; JULY FIRST, TWO
   54  THOUSAND THIRTEEN THROUGH JUNE THIRTIETH,  TWO  THOUSAND  FOURTEEN;  AND
   55  JULY  FIRST,  TWO THOUSAND FOURTEEN THROUGH JUNE THIRTIETH, TWO THOUSAND
   56  FIFTEEN, RESPECTIVELY.  THE INDIVIDUAL ANNUAL PAYMENT  AMOUNT  SHALL  BE
       A. 342                              4
    1  MULTIPLIED  BY  THE  AVERAGE FAMILY SIZE REPORTED TO THE COMMISSIONER BY
    2  THE SUPERINTENDENT OF INSURANCE TO ESTABLISH  THE  "FAMILY  UNIT  ANNUAL
    3  PAYMENT  AMOUNT"  IN  THE  SUBURBAN  REGION FOR JULY FIRST, TWO THOUSAND
    4  ELEVEN  THROUGH  JUNE  THIRTIETH,  TWO  THOUSAND TWELVE; JULY FIRST, TWO
    5  THOUSAND TWELVE THROUGH JUNE  THIRTIETH,  TWO  THOUSAND  THIRTEEN;  JULY
    6  FIRST,  TWO THOUSAND THIRTEEN THROUGH JUNE THIRTIETH, TWO THOUSAND FOUR-
    7  TEEN; AND JULY FIRST, TWO THOUSAND FOURTEEN THROUGH JUNE THIRTIETH,  TWO
    8  THOUSAND FIFTEEN, RESPECTIVELY.
    9    7.  MONTHLY PAYMENTS.  WITHIN THIRTY DAYS AFTER THE END OF EACH MONTH,
   10  A DESIGNATED THIRD-PARTY PAYOR SHALL REMIT TO THE  COMMISSIONER  OR  THE
   11  COMMISSIONER'S  DESIGNEE  ONE-TWELFTH  OF  THE INDIVIDUAL ANNUAL PAYMENT
   12  AMOUNT FOR EACH OF THE INDIVIDUALS RESIDING IN THE SUBURBAN REGION WHICH
   13  WERE INCLUDED IN THE MEMBERSHIP ROLLS  OF  THAT  DESIGNATED  THIRD-PARTY
   14  PAYOR  DURING  ALL OR ANY PORTION OF THE PRIOR MONTH. WITHIN THIRTY DAYS
   15  AFTER THE END OF EACH MONTH, A DESIGNATED THIRD-PARTY PAYOR SHALL  REMIT
   16  TO  THE  COMMISSIONER  OR THE COMMISSIONER'S DESIGNEE ONE-TWELFTH OF THE
   17  FAMILY UNIT ANNUAL PAYMENT AMOUNT FOR EACH FAMILY  UNIT  FOR  WHICH  THE
   18  PRIMARY  INSURED  RESIDED  IN THE SUBURBAN REGION WHICH WERE INCLUDED IN
   19  THE MEMBERSHIP ROLLS OF THAT DESIGNATED THIRD-PARTY PAYOR DURING ALL  OR
   20  ANY PORTION OF THE PRIOR MONTH.
   21    8. PROSPECTIVE ADJUSTMENTS.  THE COMMISSIONER SHALL ANNUALLY RECONCILE
   22  THE  SUM  OF THE ACTUAL PAYMENTS MADE TO THE COMMISSIONER OR THE COMMIS-
   23  SIONER'S DESIGNEE PURSUANT TO  THIS  SECTION  WITH  SIXTY-SEVEN  MILLION
   24  DOLLARS.  THE  DIFFERENCE  BETWEEN  THE  ACTUAL PAYMENTS AND SIXTY-SEVEN
   25  MILLION DOLLARS SHALL BE APPLIED AS  A  PROSPECTIVE  ADJUSTMENT  TO  THE
   26  TOTAL  AMOUNT  DUE  FOR  THE  YEAR NEXT FOLLOWING THE CALCULATION OF THE
   27  RECONCILIATION. THE AUTHORIZED DOLLAR VALUE OF THE ADJUSTMENTS SHALL  BE
   28  THE SAME AS IF CALCULATED RETROSPECTIVELY.
   29    9.  REPORTED  DATA.    THE  COMMISSIONER  SHALL  HAVE THE AUTHORITY TO
   30  REQUIRE  THE  DESIGNATED  THIRD-PARTY  PAYORS  TO   PROVIDE   ADDITIONAL
   31  GEOGRAPHIC  BREAKDOWN  OF THE INDIVIDUAL MEMBER MONTHS AND FAMILY MEMBER
   32  MONTHS REPORTED PURSUANT TO SUBDIVISION  FOUR  OF  SECTION  TWENTY-EIGHT
   33  HUNDRED  SEVEN-T  OF  THIS ARTICLE IN ORDER FOR THE COMMISSIONER TO HAVE
   34  INDIVIDUAL MEMBER MONTHS AND  FAMILY  MEMBER  MONTHS  FOR  THE  SUBURBAN
   35  REGION.
   36    S  3.  Subdivision  8  of  section 2807-t of the public health law, as
   37  added by chapter 639 of the laws of 1996, is amended to read as follows:
   38    8. Liability  for  assessments.  (a)  The  assessments  determined  in
   39  accordance  with  this section AND THE PAYMENTS DETERMINED IN ACCORDANCE
   40  WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-Z OF  THIS  ARTICLE  shall,  for
   41  individuals who have paid premiums directly to an insurer or to a health
   42  maintenance  organization  certified  pursuant  to article forty-four of
   43  this chapter or article forty-three of the insurance law for health care
   44  coverage which includes coverage of inpatient hospital services, be  the
   45  liability  of said individuals. The assessments determined in accordance
   46  with this section AND THE PAYMENTS DETERMINED IN ACCORDANCE WITH SECTION
   47  TWENTY-EIGHT HUNDRED SEVEN-Z OF THIS ARTICLE shall, for groups and enti-
   48  ties who have paid premiums to an insurer or  to  a  health  maintenance
   49  organization certified pursuant to article forty-four of this chapter or
   50  article  forty-three of the insurance law for health care coverage which
   51  includes coverage of inpatient hospital services, be  the  liability  of
   52  said  groups and entities. The assessments determined in accordance with
   53  this section shall,  for  individuals,  groups  and  entities  who  have
   54  contributed  to  a  self-insured  fund  for  health  care coverage which
   55  includes coverage of inpatient hospital services, be  the  liability  of
   56  said individuals, groups or entities.
       A. 342                              5
    1    (b)  Specified  third-party  payors  AND DESIGNATED THIRD-PARTY PAYORS
    2  shall make payments to the commissioner or the  commissioner's  designee
    3  of the full amount of the assessments determined in accordance with this
    4  section   AND   THE  PAYMENTS  DETERMINED  IN  ACCORDANCE  WITH  SECTION
    5  TWENTY-EIGHT  HUNDRED  SEVEN-Z  OF  THIS  ARTICLE. Specified third-party
    6  payors AND DESIGNATED THIRD-PARTY PAYORS may recover amounts due or paid
    7  to the commissioner or the  commissioner's  designee  from  the  parties
    8  liable in accordance with paragraph (a) of this subdivision.
    9    S  4.  Paragraph  (a) of subdivision 8 of section 2807-j of the public
   10  health law, as amended by section 26 of subpart D of part V-1 of chapter
   11  57 of the laws of 2009, is amended to read as follows:
   12    (a) If a payment made pursuant to this section or to  section  twenty-
   13  eight  hundred  seven-s or twenty-eight hundred seven-t OR SECTION TWEN-
   14  TY-EIGHT HUNDRED SEVEN-Z of this article for a month to which an  allow-
   15  ance OR PAYMENT applies is less than ninety percent of the amount due or
   16  which  the  commissioner  estimates,  based  on  available financial and
   17  statistical data, is due for such month, interest shall be due and paya-
   18  ble to the commissioner by a designated provider of services,  or  by  a
   19  third-party  payor,  other  than  a  state governmental agency, that has
   20  elected OR IS REQUIRED to pay an allowance OR PAYMENT directly,  on  the
   21  difference between the amount paid and the amount due or estimated to be
   22  due  from  the  day  of  the month the payment was due until the date of
   23  payment. The rate of interest shall be twelve percent per annum  or,  if
   24  greater, at the rate of interest set by the commissioner of taxation and
   25  finance  with respect to underpayments of tax pursuant to subsection (e)
   26  of section one thousand ninety-six of the tax law minus four  percentage
   27  points.  Interest  under  this paragraph shall not be paid if the amount
   28  thereof is less than one dollar. Interest due from a designated provider
   29  of services, if not paid by  the  due  date  of  the  following  month's
   30  payment,  may be collected by the commissioner pursuant to paragraph (c)
   31  of subdivision six of this section in the same manner  as  an  allowance
   32  pursuant to subdivision two of this section.
   33    S 5. Notwithstanding the expiration date of sections 2807-t and 2807-j
   34  of  the  public health law, such sections shall remain in effect through
   35  June 30, 2015 with regard to their application to section 2807-z of  the
   36  public health law.
   37    S  6.  This  act shall take effect July 1, 2011; provided, however, if
   38  this act shall become a law after such date it shall take  effect  imme-
   39  diately and shall be deemed to have been in full force and effect on and
   40  after  July  1, 2011; provided, however, that the amendments to subdivi-
   41  sion 8 of section 2807-t of the public health law made by section  three
   42  of this act shall not affect the expiration of such section and shall be
   43  deemed  to  expire  therewith;  provided  further that the amendments to
   44  paragraph (a) of subdivision 8 of section 2807-j of  the  public  health
   45  law  made by section four of this act shall not affect the expiration of
   46  such section and shall be deemed to expire  therewith.  Effective  imme-
   47  diately, the addition, amendment and/or repeal of any rule or regulation
   48  necessary  for  the implementation of this act on its effective date are
   49  authorized and directed to be made  and  completed  on  or  before  such
   50  effective date.
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