senate Bill S4528

Signed by Governor Amended

Relates to the statewide immunization information system and the administration of certain immunizations

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed by Governor
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actions

  • 08 / Apr / 2013
    • REFERRED TO HEALTH
  • 10 / Jun / 2013
    • 1ST REPORT CAL.1168
  • 11 / Jun / 2013
    • AMENDED (T) 4528A
  • 11 / Jun / 2013
    • 2ND REPORT CAL.
  • 12 / Jun / 2013
    • ADVANCED TO THIRD READING
  • 20 / Jun / 2013
    • PASSED SENATE
  • 20 / Jun / 2013
    • DELIVERED TO ASSEMBLY
  • 20 / Jun / 2013
    • REFERRED TO CODES
  • 21 / Jun / 2013
    • SUBSTITUTED FOR A7734A
  • 21 / Jun / 2013
    • ORDERED TO THIRD READING RULES CAL.704
  • 21 / Jun / 2013
    • PASSED ASSEMBLY
  • 21 / Jun / 2013
    • RETURNED TO SENATE
  • 02 / Jul / 2013
    • DELIVERED TO GOVERNOR
  • 12 / Jul / 2013
    • SIGNED CHAP.154

Summary

Relates to the statewide immunization information system and the administration of certain immunizations.

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Bill Details

Versions:
S4528
S4528A
Legislative Cycle:
2013-2014
Law Section:
Public Health Law
Laws Affected:
Amd §2168, Pub Health L; amd §§6527, 6909, 6801 & 6802, Ed L; amd §8, Chap 563 of 2008; amd §§5 & 6, Chap 116 of 2012

Votes

12
0
12
Aye
0
Nay
5
aye with reservations
0
absent
0
excused
0
abstained
show Health committee vote details

Sponsor Memo

BILL NUMBER:S4528

TITLE OF BILL: An act to amend the public health law, in relation to
the statewide immunization information system; to amend the education
law, in relation to the administration of certain immunizations; and
to amend chapter 563 of the laws of 2008, amending the education law
and the public health law relating to immunizing agents to be
administered to adults by pharmacists and chapter 116 of the laws of
2012, amending the education law relating to authorizing a licensed
pharmacist and certified nurse practitioner to administer certain
immunizing agents, in relation to making the provisions thereof
permanent

Purpose: This bill would enhance the effectiveness of the State's
efforts to reduce the incidence of vaccine-preventable disease by: (1)
expanding access to information maintained in the New York Statewide
Immunization Information System (NYSIIS) to colleges, professional
schools, technical schools, children's camps, cities, the Indian
Health Service, tribal nations and academic researchers; (2)
permitting adults to give oral consent rather than written consent for
their immunizations to be recorded in NYSIIS; and (3) expanding and
making permanent the authority of qualified pharmacists to administer
certain immunizations to adults.

Summary of Provisions:

Section 1 of the bill would amend Public Health Law (PHL) § 2168(2)(a)
to include colleges, professional and technical schools, and
children's overnight camps and summer day camps, as "authorized users"
of NYSIIS and the New York City Citywide Immunization Registry (CIR).

Section 2. of the bill would amend PHL § 2168(3)(a) to provide that
individuals who are 19 years or older can consent to have their
immunizations registered in NYSIIS and CIR verbally rather than in
writing.

Section 3 of the bill would amend PHL § 2168(5)(f) to make a technical
correction to a statutory reference relating to exemptions from
immunizations.

Section 4 of the bill would amend PHL § 2168(8)(d) to permit colleges
and professional and technical schools to access NYSIIS and CIR for
the purpose of verifying immunization status for eligibility for
admission and to allow access by children's overnight camps and summer
day camps for verifying immunization status of children attending
camp.

Section 5 of the bill would add new PHL § 2168(8)(e) to authorize
institutes of higher education, medical research centers or similar
institutions to access de-identified information in NYSIIS or CIR for
the purpose of epidemiological or other public health research, if
approved by the Commissioner of Health (Commissioner) or the
Commissioner of the New York City Department of Health and Mental
Hygiene (DOHMH), as appropriate.

Section 6 of the bill would amend PHL § 2168(11) to permit patient
specific information contained in NYSIIS or CIR to be shared with city


registries and registries maintained by the Indian Health Service or
tribal nations recognized by the State or the United States

Section 7 of the bill would amend Education Law § 6527(7) to allow a
licensed physician to issue a patient specific or non-patient specific
regimen to a licensed pharmacist for immunizations to prevent acute
herpes zoster, tetanus, diphtheria, or pertussis.

Section 8 of the bill would amend Education Law § 6909(7) to allow a
certified nurse practitioner to issue a patient specific or
non-patient specific regimen to a licensed pharmacist for
immunizations to prevent acute herpes zoster, tetanus, diphtheria, or
pertussis.

Section 9 of the bill would amend Education Law § 6801(2), (4) and (5)
so that pharmacists no longer need report the administration of an
immunization to the Department of Health (DOH) and to eliminate the
requirement for a report by the Commissioner to the Governor and
Legislature on the impact of permitting pharmacist immunizations on
the supply of vaccines.

Section 10 of the bill would amend Education Law § 6802(22) so that
(1) pharmacists who are appropriately certified may administer acute
herpes zoster, tetanus, diphtheria, and pertussis immunizations to
adults; (2) for non-patient specific regimens, a licensed physician or
certified nurse practitioner is not required to have a practice site
in the county in which the immunization is administered; and (3) the
Commissioner may issue a statewide non-patient specific regimen to
pharmacists for immunizations if he or she determines that there is an
outbreak of disease or the imminent threat of an outbreak of disease.

Section 11 of the bill would amend Chapter 563 of the Laws of 2008 to
make permanent the authority of pharmacists with appropriate
certification to administer immunizations against influenza and
pneumoccocal disease.

Section 12 of the bill would amend Chapter 116 of the Laws of 2012,
5, to eliminate the requirement that DOH submit a report to the
Governor and Legislature on insurance coverage for acute herpes zoster
immunizations in New York State. Section 12 also would amend Chapter
116 of the Laws of 2012, § 6, to make permanent the authority of
pharmacists with appropriate certification to administer immunizations
against acute herpes zoster disease.

Section 13 of the bill provides that the bill would take effect
immediately.

Existing Law: PHL § 2164 requires all children under the age of 18 to
receive immunization against poliomyelitis, mumps, measles,
diphtheria, rubella, varicella, Haemophilus influenzae type B,
pertussis, tetanus, pneumococcal disease, and hepatitis B.

PHL § 2165 requires students to provide proof of immunization against
measles, mumps and rubella upon enrollment at a college or university
within the State.


PHL § 2168 establishes NYSIIS. Education Law §§ 6801 and 6802
authorize pharmacists to administer adult immunizations against
influenza, pneumococcal and acute herpes zoster disease.

Education Law §§ 6527 and 6909 authorize licensed physicians and
certified nurse practitioners to issue patient specific and
non-patient specific orders to pharmacists for adult immunizations to
prevent influenza, pneumococcal and acute herpes zoster disease.

Legislative History: This is a new bill.

Statement in Support: Easing the incorporation of adult immunization
information into NYSIIS would help the program meet its overarching
goal: the establishment of a fully-developed database of complete,
accurate and secure immunization records. As a central repository for
immunization records, NYSIIS - the statewide system which encompasses
New York City's CIR - aids, coordinates and promotes cost-effective
disease prevention and control efforts. NYSIIS tracks the
immunizations a person has received, even if a patient sees multiple
providers, helping DOH sustain high immunization rates and low disease
levels through the efficient management of information Thus, this bill
would enhance the effectiveness of NYSIIS in several ways.

First, some colleges and universities, including the State University
of New York and the City University of New York, have health care
providers who are "authorized users" of NYSIIS and CIR with respect to
persons seeking or receiving a health care service from that provider,
Post-secondary schools, however, are not otherwise currently
"authorized users" of NYSIIS or CIR and therefore cannot use the
database to efficiently assess the immunization status of their
students. By permitting these institutions, as well as professional
and technical schools and overnight and summer camps, to access NYSIIS
and CIR, they would more easily verify the immunization status of
incoming students as required under PHL § 2165.

Second, immunizations of adults currently are recorded in NYSIIS only
if an individual consents in writing. This bill would let them consent
orally and would allow an adult, who is reluctant to sign a written
document the opportunity to be included in NYSIIS, while maintaining
his or her ability to refuse to give oral consent and still receive
immunizations.

Third, the bill would permit de-identified NYSIIS data to be shared
with academic institutions or similar entities conducting public
health research. Such research is expected to include analysis of
trends and patterns of immunization, which would help identify
populations at risk and disparities among immunization coverage
levels, and would give DOH access to expertise in data analysis,
research and evaluation that might otherwise be unavailable.
Institutions would be required to seek approval for such access, which
would be granted for the NYSIIS database only in the discretion of DOH
or, for CIR, in the discretion of DOHMH.

Fourth, PHL § 2168 currently permits NYSIIS to share immunization
information with "other state" registries pursuant to written
agreements requiring such other registries to adhere to national
standards protecting the integrity of the information. This bill would


permit NYSIIS similarly to share registrant-specific information,
including lead test records, with registries maintained by cities, the
Indian Health Service and tribal nations recognized by the State or
the United States, enhancing their ability to verify immunizations
among their populations while increasing the amount of immunization
information available in NYSIIS.

Fifth, the bill would improve overall efforts to reduce the incidence
of vaccine-preventable disease by expanding access to immunizations in
the pharmacy setting. Currently, a licensed physician or a certified
nurse practitioner may issue an order to a licensed pharmacist located
in the same or an adjoining county for the administration of
immunizations to prevent influenza, pneumococcal disease or acute
herpes zoster (commonly known as shingles) and medications required
for emergency treatment of anaphylaxis. The pharmacist must undergo
training and be certified to provide such immunizations pursuant to
regulations issued by the State Education Department (SED).

Sixth, the provisions that permit pharmacists to administer acute
herpes zoster immunizations are scheduled to sunset on July 1, 2015,
and that permit pharmacists to administer influenza and pneumococcal
immunizations are scheduled to sunset on March 31, 2016. Because the
provisions have successfully expanded access to important
immunizations, this bill would make them permanent. In addition, the
bill would authorize pharmacists, who receive certification to offer
immunizations, pursuant to SED regulations, to administer
immunizations against acute herpes zoster disease to adults, pursuant
to a non-patient specific regimen The bill would also authorize
certified pharmacists to administer immunizations against tetanus,
diphtheria, or pertussis ("Tdap") to adults, thus expanding access to
such immunizations In particular, pertussis activity continues to rise
nationally, as well as throughout New York State. Infants too young to
be immunized are at highest risk of experiencing severe consequences
of pertussis, including death.

Seventh, the bill would make it easier for pharmacists in smaller
counties to obtain non-patient specific orders from physicians and
nurse practitioners. Currently, if a county has a population of 75,000
or less, pharmacists may immunize under a standing order written by a
health care provider from an adjacent county. Eliminating this
provision and authorizing physicians and nurse practitioners who may
not have a practice site in the same or adjoining county in which the
immunization is administered to issue standing orders would expand the
options available to pharmacists operating in small counties across
the State. Pharmacists in counties previously unable to immunize
because of a lack of available licensed physicians or certified nurse
practitioners allowed to issue non-patient specific regimens will now
be able to reach out to providers in other counties for the necessary
standing order. Standing orders are an effective means of increasing
immunization rates and are recommended by the United States Preventive
Services Task Force (USPSTF) in its Guide to Community Preventive
Services.

Eight, the bill would permit the Commissioner to issue a statewide
non-patient specific regimen to pharmacists for immunizations if he or
she determines that there is an outbreak of disease or the imminent
threat of an outbreak of disease Allowing the Commissioner to issue a


statewide order for a non-patient specific regimen during an outbreak
of disease or the imminent threat of an outbreak of disease will serve
to expedite vaccination efforts in times of emergency. Local health
departments and local physicians faced with responding to an outbreak
in their community would be relieved of the burden of having to issue
such regimens themselves.

Finally, the bill would eliminate reporting requirements that DOH
believes to be unnecessary, including the reporting of each pharmacist
administration of an immunization to DOH, the submission of a report
on the impact of pharmacist immunizations on the supply of vaccines,
and the submission of a report on insurance coverage for acute herpes
zoster immunizations in New York State.

Budget Implications: This bill is not anticipated to have a fiscal
impact on the State.

Effective Date: This bill would take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4528

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              April 8, 2013
                               ___________

Introduced by Sen. HANNON -- (at request of the Department of Health) --
  read  twice  and  ordered printed, and when printed to be committed to
  the Committee on Health

AN ACT to amend the public health law,  in  relation  to  the  statewide
  immunization  information  system;  to  amend  the  education  law, in
  relation to the administration of certain immunizations; and to  amend
  chapter  563  of  the laws of 2008, amending the education law and the
  public health law relating to immunizing agents to be administered  to
  adults  by  pharmacists  and chapter 116 of the laws of 2012, amending
  the education law relating to authorizing a  licensed  pharmacist  and
  certified  nurse practitioner to administer certain immunizing agents,
  in relation to making the provisions thereof permanent

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  (a)  of  subdivision  2 of section 2168 of the
public health law, as amended by section 7 of part A of  chapter  58  of
the laws of 2009, is amended to read as follows:
  (a) The term "authorized user" shall mean any person or entity author-
ized to provide information to or to receive information from the state-
wide  immunization  information  system  and  shall  include health care
providers and their designees, as  defined  in  paragraph  (d)  of  this
subdivision,  schools  as  defined  in paragraph a of subdivision one of
section twenty-one hundred sixty-four of this title, COLLEGES AS DEFINED
IN SECTION TWO OF THE EDUCATION LAW, PROFESSIONAL AND TECHNICAL  SCHOOLS
AS  REFERRED  TO IN THE DEFINITION OF HIGHER EDUCATION IN SECTION TWO OF
THE EDUCATION LAW, CHILDREN'S OVERNIGHT CAMPS AND SUMMER  DAY  CAMPS  AS
DEFINED  IN  SECTION  THIRTEEN HUNDRED NINETY-TWO OF THIS CHAPTER, third
party payer as defined in  paragraph  (f)  of  this  subdivision,  local
health  districts  as  defined  by  paragraph  (c) of subdivision one of
section two of this chapter, local social  services  districts  and  the
office  of children and family services with regard to children in their

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09021-02-3

S. 4528                             2

legal custody, and WIC programs as defined  in  paragraph  (g)  of  this
subdivision.  An  authorized user may be located outside New York state.
An entity other than a local health district shall be an authorized user
only with respect to a person seeking or receiving a health care service
from  the  health  care  provider,  a  person  enrolled or seeking to be
enrolled in the school, a person insured by the  third  party  payer,  a
person  in  the  custody  of  the  local social services district or the
office of children and family services, or a person seeking or receiving
services through WIC programs, as the case may be.
  S 2. Paragraph (a) of subdivision 3 of  section  2168  of  the  public
health  law, as amended by section 7 of part A of chapter 58 of the laws
of 2009, is amended to read as follows:
  (a) Any health care provider who administers any vaccine to  a  person
less  than  nineteen  years  of age or, on or after September first, two
thousand nine, conducts a blood lead analysis of a sample obtained  from
a person under eighteen years of age in accordance with paragraph (h) of
subdivision  two of this section; and immunizations received by a person
less than nineteen years of age in the past  if  not  already  reported,
shall  report  all  such immunizations and the results of any blood lead
analysis to the department in a format prescribed  by  the  commissioner
within  fourteen  days  of  administration  of  such immunizations or of
obtaining the results of any  such  blood  lead  analysis.  Health  care
providers  administering  immunizations  to  persons  less than nineteen
years of age in  the  city  of  New  York  shall  report,  in  a  format
prescribed  by  the  city  of New York commissioner of health and mental
hygiene, all such immunizations to the citywide  immunization  registry.
The  commissioner,  and  for  the  city  of New York the commissioner of
health and mental hygiene, shall  have  the  discretion  to  accept  for
inclusion in the system information regarding immunizations administered
to individuals nineteen years of age or older with the [express written]
consent  of the [vaccine] VACCINEE.  Health care providers who conduct a
blood lead analysis on a person under eighteen  years  of  age  and  who
report the results of such analysis to the city of New York commissioner
of  health  and  mental  hygiene  pursuant  to  New  York city reporting
requirements shall be exempt from this requirement for  reporting  blood
lead  analysis  results  to  the state commissioner of health; provided,
however, blood lead analysis data collected from physician office  labo-
ratories by the commissioner of health and mental hygiene of the city of
New  York  pursuant  to the health code of the city of New York shall be
provided to the department in a format prescribed by the commissioner.
  S 3. Paragraph (f) of subdivision 5 of  section  2168  of  the  public
health  law, as amended by section 7 of part A of chapter 58 of the laws
of 2009, is amended to read as follows:
  (f) The immunization status  of  children  exempt  from  immunizations
pursuant  to  subdivision  eight  of  [this]  section TWENTY-ONE HUNDRED
SIXTY-FOUR OF THIS TITLE and a parent  claiming  exemption  pursuant  to
subdivision  nine of section twenty-one hundred sixty-four of this title
shall be reported by the health care provider.
  S 4. Paragraph (d) of subdivision 8 of  section  2168  of  the  public
health  law, as amended by section 7 of part A of chapter 58 of the laws
of 2009, is amended to read as follows:
  (d) The following authorized users shall have access to the  statewide
immunization  information  system and the blood lead information in such
system and the citywide immunization registry for the purposes stated in
this paragraph: (i) schools for verifying immunization status for eligi-
bility for admission; (ii) COLLEGES FOR  VERIFYING  IMMUNIZATION  STATUS

S. 4528                             3

FOR  ELIGIBILITY FOR ADMISSION; (III) PROFESSIONAL AND TECHNICAL SCHOOLS
FOR VERIFYING IMMUNIZATION STATUS FOR ELIGIBILITY  FOR  ADMISSION;  (IV)
CHILDREN'S  OVERNIGHT CAMPS AND SUMMER DAY CAMPS FOR VERIFYING IMMUNIZA-
TION  STATUS  OF  CHILDREN  ATTENDING  CAMP;  (V)  third party payer for
performing quality assurance, accountability and outreach,  relating  to
enrollees  covered  by the third party payer; [(iii)] (VI) commissioners
of local social services districts with regard to  a  child  in  his/her
legal  custody;  [(iv)] (VII) the commissioner of the office of children
and family services with regard to children in their legal custody,  and
for  quality  assurance  and  accountability  of  commissioners of local
social services districts, care and treatment of children in the custody
of commissioners of local social services districts;  and  [(v)]  (VIII)
WIC programs for the purposes of verifying immunization and lead testing
status for those seeking or receiving services.
  S 5. Subdivision 8 of section 2168 of the public health law is amended
by adding a new paragraph (e) to read as follows:
  (E)  INSTITUTES OF HIGHER EDUCATION, MEDICAL RESEARCH CENTERS OR OTHER
INSTITUTIONS ENGAGED IN EPIDEMIOLOGICAL RESEARCH OR OTHER PUBLIC  HEALTH
RESEARCH  SHALL  HAVE  ACCESS TO DE-IDENTIFIED REGISTRANT INFORMATION IN
THE STATEWIDE IMMUNIZATION INFORMATION SYSTEM OR THE CITYWIDE  IMMUNIZA-
TION  REGISTRY  FOR RESEARCH PURPOSES IF APPROVED BY THE COMMISSIONER OR
THE COMMISSIONER OF THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE  OF  THE
CITY OF NEW YORK, AS APPROPRIATE.
  S  6.  Subdivision  11  of  section  2168 of the public health law, as
amended by section 7 of part A of chapter 58 of the  laws  of  2009,  is
amended to read as follows:
  11.  The commissioner, or in the city of New York, the commissioner of
the department of health and  mental  hygiene,  may  provide  registrant
specific  immunization  AND  LEAD  TEST  records  to other state OR CITY
registries AND REGISTRIES MAINTAINED BY THE INDIAN  HEALTH  SERVICE  AND
TRIBAL  NATIONS RECOGNIZED BY THE STATE OR THE UNITED STATES pursuant to
a written agreement requiring that  the  [out-of-state]  OTHER  registry
conform  to national standards for maintaining the integrity of the data
and will not be used for purposes inconsistent with  the  provisions  of
this section.
  S 7. Subdivision 7 of section 6527 of the education law, as amended by
chapter 116 of the laws of 2012, is amended to read as follows:
  7.  [(a)]  A  licensed  physician  may  prescribe  and order a PATIENT
SPECIFIC ORDER OR non-patient specific regimen to a licensed pharmacist,
pursuant to regulations promulgated by the commissioner, and  consistent
with  the  public health law, for administering immunizations to prevent
influenza [or], pneumococcal, ACUTE HERPES ZOSTER,  TETANUS,  DIPHTHERIA
OR PERTUSSIS disease and medications required for emergency treatment of
anaphylaxis.  Nothing  in  this  subdivision  shall authorize unlicensed
persons to administer immunizations, vaccines or other drugs.
  [(b) A licensed physician may prescribe and order a  patient  specific
order  to  a licensed pharmacist, pursuant to regulations promulgated by
the commissioner, and consistent with the public health law, for  admin-
istering immunizations to prevent acute herpes zoster.]
  S 8. Subdivision 7 of section 6909 of the education law, as amended by
chapter 116 of the laws of 2012, is amended to read as follows:
  7.  [(a)]  A  certified  nurse  practitioner may prescribe and order a
PATIENT SPECIFIC ORDER OR non-patient specific  regimen  to  a  licensed
pharmacist, pursuant to regulations promulgated by the commissioner, and
consistent  with  the public health law, for administering immunizations
to prevent influenza [or], pneumococcal, ACUTE HERPES  ZOSTER,  TETANUS,

S. 4528                             4

DIPHTHERIA,  OR PERTUSSIS disease and medications required for emergency
treatment of anaphylaxis. Nothing in this  subdivision  shall  authorize
unlicensed persons to administer immunizations, vaccines or other drugs.
  [(b)  A certified nurse practitioner may prescribe and order a patient
specific regimen to  a  licensed  pharmacist,  pursuant  to  regulations
promulgated  by  the commissioner, and consistent with the public health
law, for administering immunizations to prevent acute herpes zoster.]
  S 9. Subdivisions 2, 4 and 5 of section 6801  of  the  education  law,
subdivisions  2  and  4  as added by chapter 563 of the laws of 2008 and
subdivision 5 as added by chapter 116 of the laws of 2012,  are  amended
to read as follows:
  2.  A  licensed  pharmacist may execute a non-patient specific regimen
prescribed or ordered by a licensed physician or certified nurse practi-
tioner, pursuant to rules and regulations promulgated by the commission-
er. When a licensed pharmacist administers an immunizing  agent,  he  or
she shall:
  (a)  report  such  administration  to  the patient's attending primary
health care practitioner or practitioners, if any, pursuant to rules and
regulations of the commissioner; AND
  (b) provide information to the patient on the importance of  having  a
primary  health  care  practitioner,  developed  by  the commissioner of
health[; and
  (c) report such administration, absent of any  individually  identifi-
able  health  information,  to  the  department  of  health  in a manner
required by the commissioner of health].
  4. [The commissioner of health, in consultation with the commissioner,
shall prepare and submit a report to the governor and  the  legislature,
on  or  before December thirty-first, two thousand eleven, reporting the
results and evaluating the effectiveness and impact, if any,  of  imple-
mentation  of  subdivision  two  of this section upon the supply of such
immunizing agents for  the  prevention  of  influenza  and  pneumococcal
disease, upon the geographical distribution of such agents, and upon the
distribution  of  such  agents  among  health  care providers, including
physicians, and pharmacies in New York state.
  5.] When administering an immunization in  a  pharmacy,  the  licensed
pharmacist  shall provide an area for the immunization that provides for
a patient's privacy.
  S 10. Subdivision 22 of section 6802 of the education law, as  amended
by chapter 116 of the laws of 2012, is amended to read as follows:
  22.  "Administer",  for the purpose of section sixty-eight hundred one
of this article, means the direct application of an immunizing agent  to
adults,  whether by injection, ingestion or any other means, pursuant to
[a.] a patient specific order or non-patient specific regimen prescribed
or ordered by a physician or certified nurse  practitioner,  who  has  a
practice  site  in the county in which the immunization is administered,
for immunizations to prevent influenza [or], pneumococcal, ACUTE  HERPES
ZOSTER,   TETANUS,  DIPHTHERIA  OR  PERTUSSIS  disease  and  medications
required for emergency treatment of anaphylaxis [or b. a patient specif-
ic order prescribed or ordered by a physician or certified nurse practi-
tioner for immunizations to prevent acute  herpes  zoster].    [If]  FOR
NON-PATIENT  SPECIFIC REGIMENS, [the county where the immunization is to
be administered has a population of seventy-five thousand or less, then]
the licensed physician or certified nurse practitioner  [may  be  in  an
adjoining  county.  Such  administration  shall be limited to immunizing
agents to prevent influenza  or  pneumococcal  disease  and  medications
required for emergency treatment of anaphylaxis] IS NOT REQUIRED TO HAVE

S. 4528                             5

A PRACTICE SITE IN THE COUNTY IN WHICH THE IMMUNIZATION IS ADMINISTERED.
IF  THE  COMMISSIONER  OF HEALTH DETERMINES THAT THERE IS AN OUTBREAK OF
DISEASE, OR THAT THERE IS THE IMMINENT THREAT OF AN OUTBREAK OF DISEASE,
THEN THE COMMISSIONER OF HEALTH MAY ISSUE A NON-PATIENT SPECIFIC REGIMEN
APPLICABLE STATEWIDE.
  S  11.  Section  8  of  chapter  563 of the laws of 2008, amending the
education law and the public health law relating to immunizing agents to
be administered to adults by pharmacists, as amended by chapter  316  of
the laws of 2011, is amended to read as follows:
  S  8.  This  act shall take effect on the ninetieth day after it shall
have become a law [and shall expire and be  deemed  repealed  March  31,
2016].
  S  12.  Sections  5 and 6 of chapter 116 of the laws of 2012, amending
the education law relating to  authorizing  a  licensed  pharmacist  and
certified  nurse  practitioner  to administer certain immunizing agents,
are amended to read as follows:
  S 5. [The commissioner of health, in consultation with the superinten-
dent of financial services and  the  commissioner  of  education,  shall
prepare  and  submit a report to the governor and the legislature, on or
before October first, two thousand  fourteen,  regarding  the  rates  of
health insurance plan coverage for immunizations to prevent acute herpes
zoster  in  New  York  state. This information shall include, but not be
limited to, the  total  number  of  people  receiving  immunizations  to
prevent  acute  herpes  zoster from health care providers as compared to
pharmacies in New York state; the rates of coverage from  health  insur-
ance  plans,  including  Medicare, for people receiving immunizations to
prevent acute herpes zoster from health care providers  as  compared  to
pharmacies  in  New  York  state;  the  amount of co-pays and other fees
required by health  insurance  plans,  including  Medicare,  for  people
receiving  immunizations to prevent acute herpes zoster from health care
providers as compared to pharmacies in New York state;  and  a  list  of
health insurance plans that do not provide coverage for people receiving
immunizations  to prevent acute herpes zoster from health care providers
as compared to pharmacies in New York state as well  as  the  amount  or
amounts  that  are  charges  to an individual receiving immunizations to
prevent herpes zoster without any health insurance coverage.
  S 6.] This act shall take effect on the ninetieth day after  it  shall
have  become a law [and shall expire and be deemed repealed July 1, 2015
provided, that:
  (a) the amendments to subdivision 7 of section 6527 of  the  education
law  made by section one of this act shall not affect the repeal of such
subdivision and shall be deemed to be repealed therewith;
  (b) the amendments to subdivision 7 of section 6909 of  the  education
law, made by section two of this act shall not affect the repeal of such
subdivision and shall be deemed to be repealed therewith;
  (c)  the amendments to subdivision 22 of section 6802 of the education
law made by section three of this act shall not  affect  the  repeal  of
such subdivision and shall be deemed to be repealed therewith; and
  (d)  the  amendments  to  section  6801  of  the education law made by
section four of this act shall not affect the expiration of such section
and shall be deemed to expire therewith].
  S 13. This act shall take effect immediately.

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