Bill Text: NY S08137 | 2015-2016 | General Assembly | Introduced
Bill Title: Relates to utilization review program standards (Part A); relates to providing coverage for immediate access to a five day emergency supply of certain medications and prohibiting prior authorization for a prescription for buprenorphine for opioid addiction detoxification or maintenance treatment (Part B); relates to the heroin and opioid addition wraparound demonstration services program (Part C); relates to emergency services for persons intoxicated, impaired, or incapacitated by alcohol and/or substances (Part D).
Spectrum: Moderate Partisan Bill (Republican 31-7)
Status: (Passed) 2016-06-22 - SIGNED CHAP.69 [S08137 Detail]
Download: New_York-2015-S08137-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8137 IN SENATE June 13, 2016 ___________ Introduced by Sens. ORTT, CARLUCCI -- (at request of the Governor) -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the insurance law and the public health law, in relation to utilization review program standards (Part A); to amend the insur- ance law, in relation to providing coverage for immediate access to a five day emergency supply of certain medication; to amend the social services law and the public health law, in relation to prohibiting prior authorization for a prescription for buprenorphine for opioid addiction detoxification or maintenance treatment (Part B); to amend the mental hygiene law, in relation to the heroin and opioid addiction wraparound demonstration services program; and to amend chapter 32 of the laws of 2014, amending the mental hygiene law relating to the heroin and opioid addiction wraparound services demonstration program, in relation to the effectiveness thereof (Part C); and to amend the mental hygiene law, in relation to emergency services for persons intoxicated, impaired, or incapacitated by alcohol and/or substances (Part D) 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 related to the treatment of heroin and opioid addictions. Each component 3 is wholly contained within a Part identified as Parts A through D. The 4 effective date for each particular provision contained within such Part 5 is set forth in the last section of such Part. Any provision in any 6 section contained within a Part, including the effective date of the 7 Part, which makes a reference to a section "of this act", when used in 8 connection with that particular component, shall be deemed to mean and 9 refer to the corresponding section of the Part in which it is found. 10 Section three of this act sets forth the general effective date of this 11 act. 12 PART A EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD12085-01-6S. 8137 2 1 Section 1. Paragraph 9 of subsection (a) of section 4902 of the insur- 2 ance law, as added by chapter 41 of the laws of 2014, is amended to read 3 as follows: 4 (9) When conducting utilization review for purposes of determining 5 health care coverage for substance use disorder treatment, a utilization 6 review agent shall utilize [recognized] evidence-based and peer reviewed 7 clinical review [criteria] tools designated by the office of alcoholism 8 and substance abuse services that [is] are appropriate to the age of the 9 patient and [is deemed appropriate and approved for such use by the10commissioner of the office of alcoholism and substance abuse services in11consultation with the commissioner of health and the superintendent.12The office of alcoholism and substance abuse services in consultation13with the commissioner of health and the superintendent shall approve a14recognized evidence-based and peer reviewed clinical review criteria, in15addition to any other approved evidence-based and peer reviewed clinical16review criteria] consistent with the treatment service levels within the 17 office of alcoholism and substance abuse services system. All approved 18 tools shall have inter rater reliability testing completed by December 19 thirty-first, two thousand sixteen. 20 § 2. Paragraph (i) of subdivision 1 of section 4902 of the public 21 health law, as added by chapter 41 of the laws of 2014, is amended to 22 read as follows: 23 (i) When conducting utilization review for purposes of determining 24 health care coverage for substance use disorder treatment, a utilization 25 review agent shall utilize [recognized] evidence-based and peer reviewed 26 clinical review [criteria] tools designated by the office of alcoholism 27 and substance abuse services that [is] are appropriate to the age of the 28 patient and [is deemed appropriate and approved for such use by the29commissioner of the office of alcoholism and substance abuse services in30consultation with the commissioner and the superintendent of financial31services.32The office of alcoholism and substance abuse services in consultation33with the commissioner and the superintendent of financial services shall34approve a recognized evidence-based and peer reviewed clinical review35criteria, in addition to any other approved evidence-based and peer36reviewed clinical review criteria] consistent with the treatment service 37 levels within the office of alcoholism and substance abuse services 38 system. All approved tools shall have inter rater reliability testing 39 completed by December thirty-first, two thousand sixteen. 40 § 3. Any utilization review agent utilizing evidence-based and peer 41 reviewed clinical review criteria approved by the office of alcoholism 42 and substance abuse services on or before the effective date of this act 43 shall have until December 31, 2016 to have their review tools redesig- 44 nated by the office of alcoholism and substance abuse services pursuant 45 to paragraph 9 of subsection (a) of section 4902 of the insurance law. 46 § 4. This act shall take effect immediately and shall apply to poli- 47 cies and contracts issued, renewed, modified, altered or amended on and 48 after January 1, 2017. 49 PART B 50 Section 1. Subsection (i) of section 3216 of the insurance law is 51 amended by adding a new paragraph 31-a to read as follows: 52 (31-a) (A) Every policy that provides medical, major medical or simi- 53 lar comprehensive-type coverage and provides coverage for prescription 54 drugs for medication for the treatment of a substance use disorder shallS. 8137 3 1 include immediate access, without prior authorization, to a five day 2 emergency supply of prescribed medications covered under the policy for 3 the treatment of substance use disorder where an emergency condition 4 exists, including a prescribed drug or medication associated with the 5 management of opioid withdrawal and/or stabilization, except where 6 otherwise prohibited by law. Further, coverage of an emergency supply 7 shall include medication for opioid overdose reversal otherwise covered 8 under the policy prescribed to an individual covered by the policy. 9 (B) For purposes of this paragraph, an "emergency condition" means a 10 substance use disorder condition that manifests itself by acute symptoms 11 of sufficient severity, including severe pain or the expectation of 12 severe pain, such that a prudent layperson, possessing an average know- 13 ledge of medicine and health, could reasonably expect the absence of 14 immediate medical attention to result in: 15 (i) placing the health of the person afflicted with such condition in 16 serious jeopardy, or in the case of a behavioral condition, placing the 17 health of such person or others in serious jeopardy; 18 (ii) serious impairment to such person's bodily functions; 19 (iii) serious dysfunction of any bodily organ or part of such person; 20 (iv) serious disfigurement of such person; or 21 (v) a condition described in clause (i), (ii), or (iii) of section 22 1867(e)(1)(A) of the Social Security Act. 23 (C) Coverage provided under this paragraph may be subject to copay- 24 ments, coinsurance, and annual deductibles that are consistent with 25 those imposed on other benefits within the policy; provided, however, no 26 policy shall impose an additional copayment or coinsurance on an insured 27 who received an emergency supply of medication and then received up to a 28 thirty day supply of the same medication in the same thirty day period 29 in which the emergency supply of medication was dispensed. This subpara- 30 graph shall not preclude the imposition of a copayment or coinsurance on 31 the initial emergency supply of medication in an amount that is less 32 than the copayment or coinsurance otherwise applicable to a thirty day 33 supply of such medication, provided that the total sum of the copayments 34 or coinsurance for an entire thirty day supply of the medication does 35 not exceed the copayment or coinsurance otherwise applicable to a thirty 36 day supply of such medication. 37 § 2. Subsection (l) of section 3221 of the insurance law is amended by 38 adding two new paragraphs 7-a and 7-b to read as follows: 39 (7-a) Every policy that provides medical, major medical or similar 40 comprehensive-type large group coverage shall provide coverage for medi- 41 cation for the detoxification or maintenance treatment of a substance 42 use disorder approved by the food and drug administration for the detox- 43 ification or maintenance treatment of substance use disorder. 44 (7-b) (A) Every policy that provides medical, major medical or similar 45 comprehensive-type coverage and provides coverage for prescription drugs 46 for medication for the treatment of a substance use disorder shall 47 include immediate access, without prior authorization, to a five day 48 emergency supply of prescribed medications covered under the policy for 49 the treatment of substance use disorder where an emergency condition 50 exists, including a prescribed drug or medication associated with the 51 management of opioid withdrawal and/or stabilization, except where 52 otherwise prohibited by law. Further, coverage of an emergency supply 53 shall include medication for opioid overdose reversal otherwise covered 54 under the policy prescribed to an individual covered by the policy. 55 (B) For purposes of this paragraph, an "emergency condition" means a 56 substance use disorder condition that manifests itself by acute symptomsS. 8137 4 1 of sufficient severity, including severe pain or the expectation of 2 severe pain, such that a prudent layperson, possessing an average know- 3 ledge of medicine and health, could reasonably expect the absence of 4 immediate medical attention to result in: 5 (i) placing the health of the person afflicted with such condition in 6 serious jeopardy, or in the case of a behavioral condition, placing the 7 health of such person or others in serious jeopardy; 8 (ii) serious impairment to such person's bodily functions; 9 (iii) serious dysfunction of any bodily organ or part of such person; 10 (iv) serious disfigurement of such person; or 11 (v) a condition described in clause (i), (ii), or (iii) of section 12 1867(e)(1)(A) of the Social Security Act. 13 (C) Coverage provided under this paragraph may be subject to copay- 14 ments, coinsurance, and annual deductibles that are consistent with 15 those imposed on other benefits within the policy; provided, however, no 16 policy shall impose an additional copayment or coinsurance on an insured 17 who received an emergency supply of medication and then received up to a 18 thirty day supply of the same medication in the same thirty day period 19 in which the emergency supply of medication was dispensed. This subpara- 20 graph shall not preclude the imposition of a copayment or coinsurance on 21 the initial emergency supply of medication in an amount that is less 22 than the copayment or coinsurance otherwise applicable to a thirty day 23 supply of such medication, provided that the total sum of the copayments 24 or coinsurance for an entire thirty day supply of the medication does 25 not exceed the copayment or coinsurance otherwise applicable to a thirty 26 day supply of such medication. 27 § 3. Section 4303 of the insurance law is amended by adding two new 28 subsections (l-1) and (l-2) to read as follows: 29 (l-1) Every contract that provides medical, major medical, or similar 30 comprehensive-type large group coverage shall provide coverage for medi- 31 cation for the detoxification or maintenance treatment of a substance 32 use disorder approved by the food and drug administration for the detox- 33 ification or maintenance treatment of substance use disorder. 34 (l-2) (1) Every contract that provides medical, major medical or simi- 35 lar comprehensive-type coverage and provides coverage for prescription 36 drugs for medication for the treatment of a substance use disorder shall 37 include immediate access, without prior authorization, to a five day 38 emergency supply of prescribed medications covered under the contract 39 for the treatment of substance use disorder where an emergency condition 40 exists, including a prescribed drug or medication associated with the 41 management of opioid withdrawal and/or stabilization, except where 42 otherwise prohibited by law. Further, coverage of an emergency supply 43 shall include medication for opioid overdose reversal otherwise covered 44 under the contract prescribed to an individual covered by the contract. 45 (2) For purposes of this paragraph, an "emergency condition" means a 46 substance use disorder condition that manifests itself by acute symptoms 47 of sufficient severity, including severe pain or the expectation of 48 severe pain, such that a prudent layperson, possessing an average know- 49 ledge of medicine and health, could reasonably expect the absence of 50 immediate medical attention to result in: 51 (i) placing the health of the person afflicted with such condition in 52 serious jeopardy, or in the case of a behavioral condition, placing the 53 health of such person or others in serious jeopardy; 54 (ii) serious impairment to such person's bodily functions; 55 (iii) serious dysfunction of any bodily organ or part of such person; 56 (iv) serious disfigurement of such person; orS. 8137 5 1 (v) a condition described in clause (i), (ii) or (iii) of section 2 1867(e)(1)(A) of the Social Security Act. 3 (3) Coverage provided under this subsection may be subject to copay- 4 ments, coinsurance, and annual deductibles that are consistent with 5 those imposed on other benefits within the contract; provided, however, 6 no contract shall impose an additional copayment or coinsurance on an 7 insured who received an emergency supply of medication and then received 8 up to a thirty day supply of the same medication in the same thirty day 9 period in which the emergency supply of medication was dispensed. This 10 paragraph shall not preclude the imposition of a copayment or coinsu- 11 rance on the initial limited supply of medication in an amount that is 12 less than the copayment or coinsurance otherwise applicable to a thirty 13 day supply of such medication, provided that the total sum of the copay- 14 ments or coinsurance for an entire thirty day supply of the medication 15 does not exceed the copayment or coinsurance otherwise applicable to a 16 thirty day supply of such medication. 17 § 4. Section 364-j of the social services law is amended by adding a 18 new subdivision 26-b to read as follows: 19 26-b. Managed care providers shall not require prior authorization for 20 an initial or renewal prescription for buprenorphine or injectable 21 naltrexone for detoxification or maintenance treatment of opioid 22 addiction unless the prescription is for a non-preferred or non-formu- 23 lary form of the drug or as otherwise required by section 1927(k)(6) of 24 the Social Security Act. 25 § 5. Section 273 of the public health law is amended by adding a new 26 subdivision 10 to read as follows: 27 10. Prior authorization shall not be required for an initial or 28 renewal prescription for buprenorphine or injectable naltrexone for 29 detoxification or maintenance treatment of opioid addiction unless the 30 prescription is for a non-preferred or non-formulary form of such drug 31 as otherwise required by section 1927(k)(6) of the Social Security Act. 32 § 6. This act shall take effect immediately; provided, sections one, 33 two, and three of this act shall take effect on the first of January 34 next succeeding the date on which it shall have become a law and shall 35 apply to policies and contracts issued, renewed, modified, altered or 36 amended on and after such date; and provided further that the amendments 37 to section 364-j of the social services law made by section four of this 38 act shall not affect the repeal of such section and shall be deemed to 39 be repealed therewith. 40 PART C 41 Section 1. Section 19.18-a of the mental hygiene law, as added by 42 chapter 32 of the laws of 2014, is amended to read as follows: 43 § 19.18-a Heroin and opioid addiction wraparound services demonstration 44 program. 45 1. The commissioner, in consultation with the department of health 46 shall develop a heroin and opioid addiction wraparound services demon- 47 stration program. This program shall provide wraparound services to 48 adolescent and adult patients during treatment, including, but not 49 limited to, inpatient and outpatient treatment, and shall be available 50 to such patients for a clinically appropriate period for up to nine 51 months after completion of such treatment program. The commissioner 52 shall identify and establish where the wraparound services demonstration 53 program will be provided. 54 2. Wraparound services shall include;S. 8137 6 1 (a) Case management services which address: 2 (i) Educational resources; 3 (ii) Legal services; 4 (iii) Financial services; 5 (iv) Social services; 6 (v) Family services; and 7 (vi) Childcare services; 8 (b) Peer supports, including peer to peer support groups; 9 (c) Employment support; and 10 (d) Transportation assistance. 11 3. Not later than [two years after the effective date of this section] 12 June 30, 2018, the commissioner shall provide the governor, the tempo- 13 rary president of the senate, the speaker of the assembly, the chair of 14 the senate standing committee on alcoholism and drug abuse and the chair 15 of the assembly committee on alcoholism and drug abuse with a written 16 evaluation of the demonstration program. Such evaluation shall, at a 17 minimum, address the overall effectiveness of this demonstration program 18 [and], identify best practices for wraparound services provided under 19 this demonstration program, and any additional wraparound services that 20 may be appropriate within each type of program operated, regulated, 21 funded, or approved by the office and address whether continuation or 22 expansion of this demonstration program is recommended. The written 23 evaluation shall be made available on the office's website. 24 § 2. Section 2 of chapter 32 of the laws of 2014, amending the mental 25 hygiene law relating to the heroin and opioid addiction wraparound 26 services demonstration program, is amended to read as follows: 27 § 2. This act shall take effect immediately and shall expire and be 28 deemed repealed [three years after such effective date] March 31, 2019. 29 § 3. This act shall take effect immediately; provided, however, that 30 the amendments to section 19.18-a of the mental hygiene law made by 31 section one of this act shall not affect the repeal of such section and 32 shall be deemed repealed therewith. 33 PART D 34 Section 1. Section 22.09 of the mental hygiene law, as added by chap- 35 ter 558 of the laws of 1999, is amended to read as follows: 36 § 22.09 Emergency services for persons intoxicated, impaired, or inca- 37 pacitated by alcohol and/or substances. 38 (a) As used in this article: 39 1. "Intoxicated or impaired person" means a person whose mental or 40 physical functioning is substantially impaired as a result of the pres- 41 ence of alcohol and/or substances in his or her body. 42 2. "Incapacitated" means that a person, as a result of the use of 43 alcohol and/or substances, is unconscious or has his or her judgment 44 otherwise so impaired that he or she is incapable of realizing and 45 making a rational decision with respect to his or her need for treat- 46 ment. 47 3. "Likelihood to result in harm" or "likely to result in harm" means 48 (i) a substantial risk of physical harm to the person as manifested by 49 threats of or attempts at suicide or serious bodily harm or other 50 conduct demonstrating that the person is dangerous to himself or 51 herself, or (ii) a substantial risk of physical harm to other persons as 52 manifested by homicidal or other violent behavior by which others are 53 placed in reasonable fear of serious physical harm.S. 8137 7 1 4. ["Hospital" means a general hospital as defined in article twenty-2eight of the public health law] "Emergency services" means immediate 3 physical examination, assessment, care and treatment of an incapacitated 4 person for the purpose of confirming that the person is, and continues 5 to be, incapacitated by alcohol and/or substances to the degree that 6 there is a likelihood to result in harm to the person or others. 7 5. "Treatment facility" means a facility designated by the commission- 8 er which may only include a general hospital as defined in article twen- 9 ty-eight of the public health law, or a medically managed or medically 10 supervised withdrawal, inpatient rehabilitation, or residential stabili- 11 zation treatment program that has been certified by the commissioner to 12 have appropriate medical staff available on-site at all times to provide 13 emergency services and continued evaluation of capacity of individuals 14 retained under this section. 15 (b) 1. An intoxicated or impaired person may come voluntarily for 16 emergency [treatment] services to a chemical dependence program or 17 treatment facility authorized by the commissioner to [give such emergen-18cy treatment] provide such emergency services. A person who appears to 19 be intoxicated or impaired and who consents to the proffered help may be 20 assisted by any peace officer acting pursuant to his or her special 21 duties, police officer, or by a designee of the director of community 22 services to return to his or her home, to a chemical dependence program 23 or treatment facility, or to any other facility authorized by the 24 commissioner to [give emergency treatment] provide such emergency 25 services. In such cases, the peace officer, police officer, or designee 26 of the director of community services shall accompany the intoxicated or 27 impaired person in a manner which is reasonably designed to assure his 28 or her safety, as set forth in regulations promulgated in accordance 29 with subdivision [(f)] (d) of this section. 30 [(c)] 2. A person who appears to be incapacitated by alcohol and/or 31 substances to the degree that there is a likelihood to result in harm to 32 the person or to others may be taken by a peace officer acting pursuant 33 to his or her special duties, or a police officer who is a member of the 34 state police or of an authorized police department or force or of a 35 sheriff's department or by the director of community services or a 36 person duly designated by him or her to a [general hospital or to any37other place authorized by the commissioner in regulations promulgated in38accordance with subdivision (f) of this section to give emergency treat-39ment, for immediate observation, care, and emergency treatment] treat- 40 ment facility for purposes of receiving emergency services. Every 41 reasonable effort shall be made to protect the health and safety of such 42 person, including but not limited to the requirement that the peace 43 officer, police officer, or director of community services or his or her 44 designee shall accompany the apparently incapacitated person in a manner 45 which is reasonably designed to assure his or her safety, as set forth 46 in regulations promulgated in accordance with subdivision [(f)] (d) of 47 this section. 48 [(d)] 3. A person who comes voluntarily or is brought without his or 49 her objection to any such facility or program in accordance with this 50 subdivision [(c) of this section] shall be given emergency care and 51 treatment at such place if found suitable therefor by authorized person- 52 nel, or referred to another suitable facility or treatment program for 53 care and treatment, or sent to his or her home. 54 4. The director of a treatment facility may receive as a patient in 55 need of emergency services any person who appears to be incapacitated as 56 defined in this section.S. 8137 8 1 [(e)] 5. A person who comes voluntarily or is brought with his or her 2 objection to [any] a treatment facility [or treatment program in accord-3ance with subdivision (c) of this section] shall be examined as soon as 4 possible but not more than twelve hours after arriving at such treatment 5 facility by an examining physician. If such examining physician deter- 6 mines that such person is incapacitated by alcohol and/or substances to 7 the degree that there is a likelihood to result in harm to the person or 8 others, he or she may be retained [for emergency treatment] to receive 9 emergency services and shall be regularly reevaluated to confirm contin- 10 ued incapacity by alcohol and/or substances to the degree that there is 11 a likelihood to result in harm to the person or others. If the examin- 12 ing physician determines at any time that such person is not incapaci- 13 tated by alcohol and/or substances to the degree that there is a likeli- 14 hood to result in harm to the person or others, he or she must be 15 released. Notwithstanding any other law, in no event may such person be 16 retained against his or her objection beyond whichever is the shorter of 17 the following: (i) the time that he or she is no longer incapacitated by 18 alcohol and/or substances to the degree that there is a likelihood to 19 result in harm to the person or others or (ii) a period longer than 20 [forty-eight] seventy-two hours. 21 [1.] 6. Every reasonable effort must be made to obtain the person's 22 consent to give prompt notification of a person's retention in a facili- 23 ty or program pursuant to this section to his or her closest relative or 24 friend, and, if requested by such person, to his or her attorney and 25 personal physician, in accordance with federal confidentiality regu- 26 lations. 27 [2.] 7. A person may not be retained pursuant to this section beyond a 28 period of [forty-eight] seventy-two hours without his or her consent. 29 Persons suitable therefor may be voluntarily admitted to a chemical 30 dependence program or facility pursuant to this article. 31 (c) Discharge procedures. 1. The discharge procedure process shall 32 begin as soon as the patient is admitted to the treatment facility and 33 shall be considered a part of the treatment planning process. The 34 discharge plan shall be developed in collaboration with the patient and 35 any significant other(s) the patient chooses to involve. If the patient 36 is a minor, the discharge plan must also be developed in consultation 37 with his or her parent or guardian, unless the minor is being treated 38 without parental consent as authorized by section 22.11 of this chapter. 39 2. No patient shall be discharged without a discharge plan which has 40 been completed and reviewed by the multi-disciplinary team prior to the 41 discharge of the patient. This review may be part of a regular treatment 42 plan review. The portion of the discharge plan which includes the refer- 43 rals for continuing care shall be given to the patient upon discharge. 44 This requirement shall not apply to patients who refuse continuing care 45 planning, provided, however, that the treatment facility shall make 46 reasonable efforts to provide information about the dangers of long term 47 substance use as well as information related to treatment including, but 48 not limited to, the OASAS HOPELINE and the OASAS Bed Availability Dash- 49 board. 50 3. The discharge plan shall be developed by the responsible clinical 51 staff member, who, in the development of such plan, shall consider the 52 patient's self-reported confidence in maintaining abstinence and follow- 53 ing an individualized relapse prevention plan. The responsible clinical 54 staff member shall also consider an assessment of the patient's home and 55 family environment, vocational/educational/employment status, and the 56 patient's relationships with significant others. The purpose of theS. 8137 9 1 discharge plan shall be to establish the level of clinical and social 2 resources available to the patient upon discharge from the inpatient 3 service and the need for the services for significant others. The 4 discharge plan shall include, but not be limited to, the following: 5 (i) identification of continuing chemical dependence services includ- 6 ing management of withdrawal or continuing stabilization and any other 7 treatment, rehabilitation, self-help and vocational, educational and 8 employment services the patient will need after discharge; 9 (ii) identification of the type of residence, if any, that the patient 10 will need after discharge; 11 (iii) identification of specific providers of these needed services; 12 and 13 (iv) specific referrals and initial appointments for these needed 14 services. 15 4. A discharge summary which includes the course and results of care 16 and treatment must be prepared and included in each patient's case 17 record within twenty days of discharge. 18 [(f)] (d) The commissioner shall promulgate all rules and regulations, 19 after consulting with representatives of appropriate law enforcement and 20 chemical dependence providers of services, establishing procedures for 21 taking intoxicated or impaired persons and persons apparently incapaci- 22 tated by alcohol and/or substances to their residences or to appropriate 23 public or private facilities for emergency [treatment] services and for 24 minimizing the role of the police in obtaining treatment of such persons 25 necessary to implement the provisions of this section, including but not 26 limited to establishing procedures for transporting incapacitated 27 persons to a treatment facility for emergency services. 28 § 2. This act shall take effect on the ninetieth day after it shall 29 have become law; provided however, that any and all regulations neces- 30 sary for the implementation of this act shall have been promulgated 31 prior to such effective date. 32 § 2. Severability clause. If any clause, sentence, paragraph, subdivi- 33 sion, section or part of this act shall be adjudged by any court of 34 competent jurisdiction to be invalid, such judgment shall not affect, 35 impair, or invalidate the remainder thereof, but shall be confined in 36 its operation to the clause, sentence, paragraph, subdivision, section 37 or part thereof directly involved in the controversy in which such judg- 38 ment shall have been rendered. It is hereby declared to be the intent of 39 the legislature that this act would have been enacted even if such 40 invalid provisions had not been included herein. 41 § 3. This act shall take effect immediately provided, however, that 42 the applicable effective date of Parts A through D of this act shall be 43 as specifically set forth in the last section of such Parts.