Bill Text: NY A04150 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to modernizing the chiropractic scope of practice; authorizes chiropractic clinical assistants.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced) 2024-01-03 - referred to higher education [A04150 Detail]

Download: New_York-2023-A04150-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4150

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 10, 2023
                                       ___________

        Introduced  by  M.  of  A.  O'DONNELL  --  read once and referred to the
          Committee on Higher Education

        AN ACT to amend the  education  law,  in  relation  to  modernizing  the
          chiropractic  scope  of  practice; and to repeal certain provisions of
          such law relating thereto

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1. Section 6551 of the education law, as added by chapter 987
     2  of the laws of 1971, paragraphs a and b of subdivision 2 as  amended  by
     3  chapter 450 of the laws of 1983, and subdivision 3 as amended by chapter
     4  683 of the laws of 1991, is amended to read as follows:
     5    § 6551. Definition  of  practice of chiropractic.   1. The practice of
     6  the profession of chiropractic is defined as [detecting  and  correcting
     7  by  manual  or  mechanical  means  structural  imbalance, distortion, or
     8  subluxations in the human body for the purpose of removing nerve  inter-
     9  ference  and  the effects thereof, where such interference is the result
    10  of or related to distortion, misalignment or subluxation of  or  in  the
    11  vertebral  column. 2.] the examination, evaluation, detection, diagnosis
    12  of the human body and/or treatment or correction of: subluxations in the
    13  vertebral column or other articular segments  by  manual  or  mechanical
    14  means,    neuromusculoskeletal    conditions,    structural   imbalance,
    15  distortion, and/or dysfunction of the human body and the effects  there-
    16  of;  including  restoring  nervous  system integrity, structural balance
    17  and/or function; as it may relate to any human  disease,  pain,  injury,
    18  deformity or physical condition.
    19    2. a. The practice of chiropractic may include, but not be limited to,
    20  physical and functional examination of patients, health assessment, work
    21  capability assessment, handicap eligibility assessment, school and other
    22  sports  assessment,  school attendance assessment, spinal health assess-
    23  ment, analysis, or to give  consultation,  advice,  recommendations  and
    24  counseling  regarding  anatomy,  physiology,  neurology,  general health

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08995-01-3
        A. 4150                             2

     1  matters, wellness and health optimization by any means of communication,
     2  the use of imaging studies using ionizing and non-ionizing imaging meth-
     3  ods,  adjustment,  mobilization,  manipulation,  traction,  and   decom-
     4  pression,  and  ancillary  procedures  consisting of but not limited to,
     5  heat, cold, light, air, water, sound, electricity, massage, manual ther-
     6  apies, therapeutic exercise with or without assistive devices and  clin-
     7  ical  laboratory  testing  methods  approved  by the department as being
     8  appropriate to the practice of chiropractic.
     9    b. Chiropractic examination, diagnostic and treatment methods may also
    10  include electrodiagnostic testing and manipulation under anesthesia when
    11  appropriate education standards have been met and  as  approved  by  the
    12  department as being appropriate to the practice of chiropractic.
    13    c.  The  practice  of the profession of chiropractic allows a licensed
    14  chiropractor who has successfully completed a registered doctoral, post-
    15  doctoral or continuing  education  certification  program  of  a  higher
    16  education credential by an accrediting agency, which contains courses of
    17  study  in wellness care methods, nutrition, and dietary advice satisfac-
    18  tory to the department; use of wellness care methods and the ability  to
    19  engage  in  nutritional  counseling  and  dietary  advice, including the
    20  dispensing of food concentrates, food  extracts,  nutraceuticals,  vita-
    21  mins,  minerals,  and  other  nutritional  supplements  approved  by the
    22  department as being appropriate to, and as a part of,  the  practice  of
    23  chiropractic.
    24    3.  a.    A license to practice as a chiropractor shall not permit the
    25  holder thereof to use [radio-therapy, fluoroscopy, or any form of ioniz-
    26  ing radiation except X-ray which shall be  used  for  the  detection  of
    27  structural  imbalance,  distortion,  or  subluxations in the human body]
    28  ionizing radiation sources for the purposes of radiotherapy.
    29    b. The requirements and limitations with respect to the use of [X-ray]
    30  diagnostic imaging studies by chiropractors shall  be  enforced  by  the
    31  state  commissioner of health and [he] the commissioner is authorized to
    32  promulgate rules and  regulations  after  conferring  with  the  [board]
    33  department to carry out the purposes of this subdivision.
    34    c.  Chiropractors  shall retain for a period of three years all [X-ray
    35  films] diagnostic images taken in the course of their practice, together
    36  with the records pertaining thereto, and shall make such [films]  images
    37  and  records available to the state commissioner of health or his or her
    38  representative on demand.
    39    [3.] 4. Chiropractors may use diagnostic clinical  laboratory  methods
    40  involving  chemical  or  biological  means  which  particular  tests and
    41  services shall be approved by the department as appropriate to the prac-
    42  tice of chiropractic.
    43    5. A license to practice chiropractic  shall  not  permit  the  holder
    44  thereof  to  treat  for  any  infectious diseases such as pneumonia, any
    45  communicable diseases listed in the sanitary code of the  state  of  New
    46  York, any of the cardio-vascular-renal or cardio-pulmonary diseases, any
    47  surgical  condition  [of  the  abdomen  such  as  acute appendicitis, or
    48  diabetes], or any benign or malignant neoplasms; to operate;  to  reduce
    49  fractures  [or  dislocations]; to prescribe, administer, dispense or use
    50  in [his] practice drugs or medicines[; or to use diagnostic or therapeu-
    51  tic methods involving chemical or  biological  means  except  diagnostic
    52  services  performed  by  clinical  laboratories  which services shall be
    53  approved by the board as appropriate to the practice of chiropractic; or
    54  to utilize electrical devices except those devices approved by the board
    55  as being appropriate to the practice  of  chiropractic.  Nothing  herein
    56  shall  be construed to prohibit a licensed chiropractor who has success-
        A. 4150                             3

     1  fully completed a registered doctoral  program  in  chiropractic,  which
     2  contains  courses  of study in nutrition satisfactory to the department,
     3  from using nutritional counseling,  including  the  dispensing  of  food
     4  concentrates,  food  extracts, vitamins, minerals, and other nutritional
     5  supplements approved by the board as being appropriate to, and as a part
     6  of, his or  her  practice  of  chiropractic.  Nothing  herein  shall  be
     7  construed  to prohibit an individual who is not subject to regulation in
     8  this state as a licensed chiropractor from engaging in nutritional coun-
     9  seling.] or controlled substances or to administer or  use  anesthetics.
    10  Chiropractors may use topical analgesic substances and anesthetic balms,
    11  salves or emollients or advise on over the counter substances.
    12    § 2. Section 6552 of the education law, as added by chapter 987 of the
    13  laws of 1971, is amended to read as follows:
    14    § 6552. Practice  of  chiropractic  and  use  of title "chiropractor",
    15  "doctor of chiropractic" or "chiropractic physician".    Only  a  person
    16  licensed  [or exempt] or otherwise authorized under this article [shall]
    17  to practice chiropractic [or] may use the title "chiropractor",  "doctor
    18  of chiropractic" or "chiropractic physician".
    19    § 3. Section 6553 of the education law, as added by chapter 987 of the
    20  laws of 1971, is amended to read as follows:
    21    § 6553. State  board for chiropractic.  A state board for chiropractic
    22  shall be appointed by the board of  regents  on  recommendation  of  the
    23  commissioner  for  the purpose of assisting the board of regents and the
    24  department on matters of professional licensing and professional conduct
    25  in accordance with section sixty-five hundred eight of this title.   The
    26  board  shall be composed of not less than [seven] eight members, includ-
    27  ing [at least four] seven licensed chiropractors[, one  licensed  physi-
    28  cian who is a doctor of medicine, one licensed physician who is a doctor
    29  of  osteopathy,  and  one  educator  who holds a doctorate or equivalent
    30  degree in either anatomy, physiology, pathology, chemistry or microbiol-
    31  ogy] in this state for at least five years and one public  member.    An
    32  executive  secretary  to  the  board  shall be appointed by the board of
    33  regents on recommendation of the commissioner.
    34    § 4. Section 6554 of the education law, as added by chapter 987 of the
    35  laws of 1971, subdivision 3 as amended by chapter 994  of  the  laws  of
    36  1971,  subdivision  6 as amended by chapter 669 of the laws of 2022, and
    37  subdivision 8 as amended by chapter 62 of the laws of 1989,  is  amended
    38  to read as follows:
    39    § 6554. Requirements  for  a  professional  license.  To qualify for a
    40  license as a chiropractor, an  applicant  shall  fulfill  the  following
    41  requirements:
    42    (1) Application: file an application with the department;
    43    (2) Education: have received an education, including [two] three years
    44  or  ninety  semester  hours of credit or equivalent trimester or quarter
    45  hours of credit of preprofessional college study  and  completion  of  a
    46  [four-year  resident  program  in chiropractic,] program of chiropractic
    47  education of not less than four academic years, or the equivalent there-
    48  of in accordance with the commissioner's regulations;
    49    (3) Experience: have experience  satisfactory  to  the  board  and  in
    50  accordance with the commissioner's regulations[:];
    51    (4)  Examination:  pass  examinations satisfactory to the board and in
    52  accordance with the commissioner's regulations[, in clinical  chiroprac-
    53  tic  analysis,  the  practice  of  chiropractic,  X-ray as it relates to
    54  chiropractic analysis, and examinations satisfactory to  the  department
    55  in  anatomy,  physiology, pathology, chemistry, microbiology, diagnosis,
    56  and the use and effect of X-ray] for the practice of chiropractic;
        A. 4150                             4

     1    (5) Age: be at least twenty-one years of age;
     2    (6) Citizenship or immigration status: be a United States citizen or a
     3  noncitizen  lawfully  admitted  for  permanent  residence  in the United
     4  States;
     5    (7) Character: be of good moral character as determined by the depart-
     6  ment; and
     7    (8) Fees: pay a fee of one hundred seventy-five dollars to the depart-
     8  ment for [admission to a department conducted examination  and  for]  an
     9  initial  license  upon  completion  and passage of a department approved
    10  examination, a fee of eighty-five dollars for each reexamination, a  fee
    11  of  one  hundred  fifteen dollars for an initial license for persons not
    12  requiring admission to a department conducted examination, and a fee  of
    13  one hundred fifty-five dollars for each triennial registration period.
    14    §  5.  Section 6555 of the education law, as amended by chapter 537 of
    15  the laws of 1983, is amended to read as follows:
    16    § 6555. Exempt persons.  [Nothing in this article shall  be  construed
    17  to  affect or prevent a student enrolled in a college of chiropractic in
    18  this state from engaging in all phases of clinical practice under super-
    19  vision of a licensed chiropractor or physician in  a  curriculum  regis-
    20  tered  by  the  department.]  The  following persons under the following
    21  limitations  may  practice  chiropractic  within  the  state  without  a
    22  license:
    23    1. A student enrolled in any accredited college of chiropractic engag-
    24  ing  in  all phases of clinical practice under supervision of a licensed
    25  chiropractor or physician in a curriculum registered by the  department;
    26  or
    27    2.  A student who is performing a clinical externship or preceptorship
    28  in a chiropractic office or clinic setting and  who  is  enrolled  in  a
    29  chiropractic  school  which  meets  the  standards  satisfactory  to the
    30  department, provided such practice is under the direct supervision of  a
    31  licensed chiropractor for a maximum period of twelve months; or
    32    3.  Any chiropractor authorized to practice chiropractic while travel-
    33  ling from another state or country in which he or she  is  licensed,  to
    34  provide  chiropractic  services during any emergency services associated
    35  with any rescue, recovery or humanitarian relief  effort  provided  such
    36  practice is limited to the organized emergency services; or
    37    4.  A  chiropractor who is not a resident of this state who is legally
    38  qualified to practice in his or her state and  who  is  travelling  from
    39  another  state  for the purpose of providing chiropractic services for a
    40  specific purpose or event of limited duration; or
    41    5. Any chiropractor who is licensed in another state  or  country  and
    42  who  is  meeting  or  communicating with a chiropractor licensed in this
    43  state, for purposes of consultation, provided such practice  is  limited
    44  to such consultation; or
    45    6.  Any  chiropractor who is licensed in another state or country, who
    46  is visiting a chiropractic school or teaching facility in this state  to
    47  receive  chiropractic  instruction for a period not to exceed six months
    48  or to conduct chiropractic instruction, provided such practice is limit-
    49  ed to such instruction  and  is  under  the  general  supervision  of  a
    50  licensed chiropractor; or
    51    7. Any chiropractor who is authorized by a foreign government to prac-
    52  tice  in  relation  to  its  diplomatic,  consular  or  maritime staffs,
    53  provided such practice is limited to such staffs; or
    54    8. Any commissioned chiropractic officer who is serving in the  United
    55  States  armed forces or public health service or any chiropractor who is
        A. 4150                             5

     1  employed in the United States  Veterans  Administration,  provided  such
     2  practice is limited to such service or employment.
     3    §  6.  Section 6556 of the education law is REPEALED and a new section
     4  6556 is added to read as follows:
     5    § 6556. Limited permits. Permits limited as to  eligibility,  practice
     6  and  duration, shall be issued by the department to eligible applicants,
     7  as follows:
     8    1. Eligibility: The following persons shall be eligible for a  limited
     9  permit:
    10    a.  A  person  who fulfills all requirements for a license as a chiro-
    11  practor except those relating to  the  examination  and  citizenship  or
    12  permanent residence in the United States;
    13    b.  A  licensed foreign chiropractor who meets guidelines developed in
    14  accordance with the commissioner's regulations;
    15    c. A licensed foreign chiropractor or a foreign intern who is in  this
    16  country  on  a non-immigration visa for the continuation of chiropractic
    17  study who meets guidelines developed in accordance with the  commission-
    18  er's regulations;
    19    d.  Any graduate of a chiropractic school which meets standards satis-
    20  factory to the department, provided such practice is under  the  general
    21  supervision  of  a  licensed chiropractor for a maximum period of twelve
    22  months from date of graduation.
    23    2. Limit of practice. A permittee  shall  be  authorized  to  practice
    24  chiropractic  only  under the supervision of a licensed chiropractor and
    25  only in a licensed chiropractic office or clinical setting.
    26    3. Duration. A limited permit shall be valid for one year.  A  limited
    27  permit may be renewed annually at the discretion of the department.
    28    4. Fees. The fee for each limited permit and for each renewal shall be
    29  one hundred five dollars.
    30    § 7. The education law is amended by adding a new section 6557 to read
    31  as follows:
    32    § 6557. Special provisions. 1. Non-liability of licensed chiropractors
    33  for  first aid or emergency treatment.  Notwithstanding any inconsistent
    34  provision of any general, special or local law, any licensed  chiroprac-
    35  tor who voluntarily and without the expectation of monetary compensation
    36  renders  first aid or emergency treatment at the scene of an accident or
    37  other emergency, outside a hospital, doctor's office or any other  place
    38  having  proper  and necessary chiropractic equipment, to a person who is
    39  unconscious, ill or injured, shall not be liable for damages  for  inju-
    40  ries  alleged  to  have been sustained by such person or for damages for
    41  the death of such person alleged to have occurred by reason of an act or
    42  omission in the rendering of  such  first  aid  or  emergency  treatment
    43  unless  it  is  established  that  such  injuries were or such death was
    44  caused by gross negligence on the part of such chiropractor. Nothing  in
    45  this  section  shall be deemed or construed to relieve a licensed chiro-
    46  practor from liability for damages for injuries or death  caused  by  an
    47  act  or  omission  on the part of a chiropractor while rendering profes-
    48  sional services in the normal and ordinary course of his  or  her  prac-
    49  tice.
    50    2.  This  article  shall  not  be  construed  to affect or prevent the
    51  following:
    52    a. The furnishing of any assistance in an emergency;
    53    b. The chiropractor from being a primary portal  of  entry  healthcare
    54  provider.
    55    3.  There  shall be no monetary liability on the part of, and no cause
    56  of action for damages shall  arise  against,  any  person,  partnership,
        A. 4150                             6

     1  corporation,  firm,  society, or other entity on account of the communi-
     2  cation of information in the possession of such person or entity, or  on
     3  account  of  any  recommendation or evaluation, regarding the qualifica-
     4  tions,  fitness, or professional conduct or practices of a chiropractor,
     5  to any governmental agency, chiropractic society, a hospital as  defined
     6  in  article twenty-eight of the public health law, a hospital as defined
     7  in subdivision ten of section 1.03 of  the  mental  hygiene  law,  or  a
     8  health  maintenance  organization  organized under article forty-four of
     9  the public health law or  article  forty-three  of  the  insurance  law,
    10  including  a  committee of an individual practice association or medical
    11  group acting pursuant to a contract with a health maintenance  organiza-
    12  tion.  The  foregoing shall not apply to information which is untrue and
    13  communicated with malicious intent.
    14    § 8. The education law is amended by adding a new section 6558 to read
    15  as follows:
    16    § 6558. Definition of chiropractic clinical assistant.   1. A  chirop-
    17  ractic clinical assistant is defined as a person certified in accordance
    18  with  this  article who works under the supervision of a licensed chiro-
    19  practor performing such patient duties as are assigned by the  supervis-
    20  ing  chiropractor.  A  chiropractic  clinical assistant may only provide
    21  patient services on the orders and instructions of a supervising  chiro-
    22  practor.  Supervision of a chiropractic clinical assistant by a licensed
    23  chiropractor shall be on-site supervision, but  not  necessarily  direct
    24  personal  supervision.  The  number  of chiropractic clinical assistants
    25  supervised by one licensed chiropractor shall not exceed  the  ratio  of
    26  four  chiropractic  clinical  assistants to one licensed chiropractor as
    27  shall be determined by  the  commissioner's  regulations  ensuring  that
    28  there  be adequate supervision in the best interest of public health and
    29  safety. Nothing in this section  shall  prohibit  a  hospital  or  other
    30  public  health  law article twenty-eight facility from employing chirop-
    31  ractic clinical assistants, provided they work under the supervision  of
    32  a  chiropractor, physician, nurse practitioner or other medical provider
    33  designated by the hospital or public  health  law  article  twenty-eight
    34  facility and not beyond the scope of practice of a chiropractic clinical
    35  assistant.
    36    2.  A certified chiropractic clinical assistant may only provide clin-
    37  ical services on the orders and instructions of a supervising chiroprac-
    38  tor.
    39    3. The scope of services for a certified chiropractic clinical assist-
    40  ant shall include assisting a chiropractor with providing certain  clin-
    41  ical  procedures  common and customary to the chiropractic setting which
    42  include, but are not  limited  to,  the  following:  collecting  general
    43  health  data,  such  as  the  taking  of an oral history, vital signs or
    44  neurological,  physiological  or  anatomical  measurements;   performing
    45  objective data collection tests common and customary to the chiropractic
    46  setting  including,  but  not  limited to dynamic or static surface EMG,
    47  thermography, heart rate  variability;  applying  thermal,  light,  air,
    48  water,  sound,  electrical  and  mechanical  modalities;  and monitoring
    49  prescribed rehabilitative activities.
    50    4. A certified chiropractic  clinical  assistant  must  be  adequately
    51  trained  in  the  proper  operation of any device or equipment and know-
    52  ledgeable of anatomy and the appropriate safety procedures and contrain-
    53  dications with respect to the clinical services he or she is directed to
    54  provide.
    55    5. Nothing in this section shall be construed  to  allow  a  certified
    56  chiropractic  clinical  assistant  to provide a chiropractic adjustment;
        A. 4150                             7

     1  manipulation; joint mobilization; perform radiological  tests  (X-rays);
     2  nutritional  instruction; and counseling or other therapeutic service or
     3  procedure which requires individual licensure in New York state.
     4    6.  Registration as a certified chiropractic clinical assistant is not
     5  required for individuals who  perform  administrative  activities  of  a
     6  non-clinical nature.
     7    § 9. The education law is amended by adding a new section 6559 to read
     8  as follows:
     9    § 6559. Duties of chiropractic clinical assistant and the use of title
    10  "chiropractic  clinical assistant." Only a person certified or otherwise
    11  authorized under this article  shall  participate  in  the  practice  of
    12  chiropractic  as  a  chiropractic  clinical  assistant and only a person
    13  certified under this section shall use the title "chiropractic  clinical
    14  assistant."
    15    §  10.  The  education  law is amended by adding a new section 6560 to
    16  read as follows:
    17    § 6560. Requirements for  certification  as  a  chiropractic  clinical
    18  assistant.
    19    1. Application: file an application with the department;
    20    2.  Education: have received an education and training in a chiroprac-
    21  tic clinical assistant program in  accordance  with  the  commissioner's
    22  regulations  and department of education; including but not limited to a
    23  minimum of twenty-four hours of didactic study;
    24    3. Experience: have experience  satisfactory  to  the  department  for
    25  chiropractic in accordance with the commissioner's regulations;
    26    4. Examination: pass an examination satisfactory to the department and
    27  in accordance with the commissioner's regulations;
    28    5. Age: be at least eighteen years of age;
    29    6.  Character: be of good moral character as determined by the depart-
    30  ment;
    31    7. Registration: all certified chiropractic clinical assistants  shall
    32  register  triennially  with  the education department in accordance with
    33  the regulations of the commissioner;
    34    8. Fees: pay a fee for an initial certificate of fifty dollars, and  a
    35  fee of fifty dollars for each subsequent triennial registration period.
    36    9.  A  certified  chiropractic  clinical assistant shall conduct them-
    37  selves within the boundaries of proper ethical behavior and shall adhere
    38  to acceptable standards of conduct regardless of whether  a  supervising
    39  chiropractor  or  person in a position of authority may order, impart or
    40  condone behavior or conduct which is improper.
    41    10. "Improper conduct", under  the  meaning  of  this  section,  shall
    42  include  conduct  delineated  under the chiropractic practice act, regu-
    43  lations, and such other New York state laws that may apply.
    44    11. The department may refuse  to  issue,  refuse  to  renew,  or  may
    45  suspend, revoke, censure, reprimand, restrict, or limit the registration
    46  of,  or  fine  any  person pursuant to the laws of New York state or the
    47  procedures set forth herein, upon one or more of the grounds for  disci-
    48  pline set forth in this article.
    49    §  11.  The  education  law is amended by adding a new section 6561 to
    50  read as follows:
    51    § 6561. Exemptions. 1. This article shall not be construed  to  affect
    52  or  prevent  a  chiropractic clinical assistant student from engaging in
    53  clinical assisting under the supervision of a licensed  chiropractor  as
    54  part  of  a  program  conducted  in an approved program for chiropractic
    55  clinical assistants or in a clinical  facility  or  health  care  agency
    56  affiliated with the program for chiropractic clinical assistants.
        A. 4150                             8

     1    2.  Supervision  of  a  chiropractic  clinical  assistant student by a
     2  licensed chiropractor shall be on-site  supervision  and  direct  super-
     3  vision.
     4    §  12.  The  education  law is amended by adding a new section 6562 to
     5  read as follows:
     6    § 6562. Limited permits. 1.  The  department  shall  issue  a  limited
     7  permit  to  an applicant who meets all requirements for admission to the
     8  certification examination.
     9    2. All practice under a limited permit shall be under the  supervision
    10  of  a  licensed  chiropractor  or  other  licensed medical provider in a
    11  public hospital, an incorporated hospital or clinic, a licensed proprie-
    12  tary hospital, a licensed nursing home, a public health agency, a recog-
    13  nized public or non-public school setting,  the  office  of  a  licensed
    14  chiropractor, or in the civil service of the state or political subdivi-
    15  sion thereof.
    16    3.  Limited permits shall be for six months and the department may for
    17  justifiable cause renew a limited  permit  provided  that  no  applicant
    18  shall  practice  under  any  limited permit for more than a total of one
    19  year.
    20    4. Supervision of a permittee by  a  licensed  chiropractor  shall  be
    21  on-site supervision and not necessarily direct personal supervision.
    22    5. The fee for each limited permit and for each renewal shall be fifty
    23  dollars.
    24    § 13. This act shall take effect on the first of January next succeed-
    25  ing the date on which it shall have become a law.