senate Bill S6001

2013-2014 Legislative Session

Provides for funding of early intervention services

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to health
Dec 02, 2013 referred to rules

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S6001 - Bill Details

Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Add §2807-o, amd §§2807-s, 2557 & 2559, Pub Health L

S6001 - Bill Texts

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Provides for state grant funding to municipalities for early intervention services for toddlers with disabilities and their families.

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BILL NUMBER:S6001

TITLE OF BILL: An act to amend the public health law, in relation to
funding early intervention services

PURPOSE:

To provide a system that streamlines the process by which funds are
distributed to municipalities to finance early intervention programs,
thereby providing vital relief to the municipalities across the state,
and to improve their ability to more effectively administer early
intervention services to children who need such services.

SUMMARY OF PROVISIONS:

Section one amends the public health law by adding a new section
2807-o that provides definitions for terms used in this section of
law. Section one also provides that the commissioner of health shall
make grants to municipalities for the delivery of early intervention
services. Such grants shall be deemed reimbursements from third party
payors to the municipalities and the State and shall be a share of
grants equal to the proportionate share of the municipality and the
State, as the case may be, of the total approved statewide dollars not
reimbursable by the medical assistance program paid by municipalities
and the State to providers of early intervention services in the last
complete state fiscal year for which such data is available.

Section two amends subdivision 6 of section 2807-s of the public
health law by adding two new paragraphs (g) and (h). Paragraph (g)
provides that a further gross statewide amount for two thousand
fourteen shall be four hundred million dollars. Paragraph (h) provides
that the four hundred million dollars specified in paragraph (g) shall
be allocated among the municipalities and the State based on the share
of each municipality and the State of early intervention program
expenditures not reimbursable by the medical assistance program for
the latest twelve month period for which such data is available.

Section three amends subdivision 7 of section 2807-s of the public
health law by adding a new paragraph (d) that provides that funds
shall be added to the funds collected by the commissioner for
distribution in accordance with section 2807-o, in the amount of four
hundred million dollars for the period January 1, 2014 through
December 31, 2014.

Section four amends subdivision 1 of section 2557 of the public health
law, subdivision 1 as amended by section 4 of part C of chapter 1 of
the laws of 2002, to delete the reference to a plan of insurance so
that benefits under this title shall be considered secondary only to
any state government benefit Program under which an eligible child may
have coverage, and to delete the provision that nothing in this
section shall increase or enhance coverages provided for within an
insurance contract subject to the provisions of this title.

Section five amends section 2557 of the public health law by adding a
new subdivision 4 to require the commissioner to collect data, by
municipality, on the early intervention program for purposes of
improving the efficiency, cost effectiveness and quality of the


program. Data to be collected shall include the number of children
enrolled in the program, the number of state approved agencies and
organizations providing early intervention services by service
specialty and the number of state approved independent providers of
early intervention services by service specialty, the number of state
approved evaluators, the number of children covered by the medical
assistance program, the number of claims submitted to the medical
assistance program by municipality, the percentage claims denied by
medical assistance and the reasons for the denials. The commissioner
shall report for the period July 1, 2014 to December 31, 2014 and for
each calendar year thereafter, to the Governor and the Legislature by
March 1 of each year the information and analysis required by this
section.

Section six amends subdivision 2 of section 2557 of the public health
law, as amended by section 9-a of part A of chapter 56 of the laws of
2012, to provide that the department shall reimburse the approved
costs paid by a municipality other than those reimbursable by the
medical assistance program, eliminating the exclusion of costs
reimbursable by third party payors.

Section seven amends the section heading of section 2559 of the public
health law, as added by chapter 428 of the laws of 1992, to eliminate
the reference to third party insurance.

Section eight amends subdivision 3 of section 2559 of the public
health law, as added by chapter 428 of the laws of 1992, paragraphs
(a), (c) and (d) as amended by section 11 of part A of chapter 56 of
the laws of 2012 and paragraph b as further amended by section 104 of
Part A of chapter 62 of the laws of 2011, to provide that providers
shall first seek payment from the medical assistance program rather
than third party payors including governmental agencies, prior to
claiming payment from a municipality for services rendered, though not
when the insured is not eligible for medical assistance pursuant to
the social services law. Section eight also deletes paragraphs
(b)requiring the commissioner to promulgate regulations providing
public reimbursement for deductibles and copayments imposed under an
insurance policy or health benefit plan to the extent that such
deductibles and copayments are applicable to early intervention
services and (c) requiring that payments made for early intervention
services under an insurance policy or health benefit plan provided as
part of an IFS? shall not be applied against any maxi- mum lifetime or
annual limits specified in the policy or health benefits plan). In
addition, section eight provides that a municipality shall be
subrogated to the extent of its expenditures f or early intervention
services furnished to eligible persons to the rights such person may
have from the medical assistance program rather than from third party
reimbursement. Except as provided in this article, no third party
payor other than the medical assistance program shall be required to
reimburse for early intervention services.

Section nine provides the effective date.

JUSTIFICATION:

The early intervention program was established under the Public Health
Law and the federal Individuals with Disabilities Education Act (IDEA)


to enhance the development of infants and toddlers from birth to age
three who have a significant developmental delay or disability, as
well as enhance the capacity of families to meet their children's
special needs. The program seeks to identify and evaluate as early as
possible those infants and toddlers whose healthy development is
compromised and to provide for appropriate therapeutic and supportive
services. With early intervention, we can reduce the number of
children with disabilities or reduce the severity of their disabling
conditions. All early intervention (EI) services must be provided to
eligible children at no cost to their families. The HI program is
financed through a combination of state and county funds, Medicaid and
commercial insurance. Although Public Health Law and IDEA mandate that
public and private commercial insurance be maximized in financing EI
services, reimbursement from third party payors, other than Medicaid,
has been minimal, leaving the cost of this entitlement to be paid by
state and municipal tax dollars.

In 2005 an aggregate 893,000 claims were submitted to commercial
insurers; 70% of the claims were denied. Further, according to a
survey by the New York State Association of County Health Officials,
for the period July 2003 to June 2004, $75.5 million in claims for EI
services were filed with commercial insurers, of which $10.6 million,
or 14%, was paid. Counties, which are required by the state to finance
and administer the EI program, are entitled to be reimbursed by the
state for 50% of their unreimbursed costs for Ed services (36% for
administration costs). Counties have billed private insurers
approximately $100 million, overshadowing the aggregate costs billed
to Medicaid. The partial funding by the state, combined with the low
rate of recoupment from third party insurers, has required
municipalities to bear an estimated 43% of the costs of providing EI
services.

To require municipalities to bear such a significant portion of the
costs of the program where the number of children served as well as
the level of services provided continues to increase imposes a
significant strain on local budgets. In New York City alone, for the
last six months of 2005, an estimated $213.1 million was incurred for
EI services, of which $800,000 was paid by commercial insurance.
Whereas in 1993 to 1994, the first year the EI program became
effective, the costs of EI services for the entire state was $40
million. Since a substantial portion of municipal budgets must be
spent on EI services, municipalities must face a shrinking balance of
available funds, forcing them to decrease or eliminate altogether
other needed services.

Recognizing that the current structure of financing EI costs is
inadequate, this bill provides a different approach to funding. The
bill would set up a statewide pool from which municipalities would be
allocated funds to pay ET costs. By allowing for the direct allocation
of funds to municipalities from the statewide pool, we will eliminate
the unwieldy and inefficient step of requiring municipalities (in the
case where the insured is not eligible for medical assistance) to seek
reimbursement of EI costs first from third party insurers and then,
only upon denial or other disposition of the claim, from the state. In
cases where the insured is eligible for medical assistance,
municipalities will remain obligated to seek reimbursement first from
the medical assistance program.


Making funds readily available and streamlining the process by which
the funds are distributed to municipalities will provide vital relief
to the municipalities across the state that have been struggling to
finance the

EI program and thereby improve their ability to more effectively
administer EI services to children who need those services.

LEGISLATIVE HISTORY:

This is a new bill.

FISCAL IMPLICATIONS:

Approximately $100 million to the state.

EFFECTIVE DATE:

This act shall take effect April 1, 2014.

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

                                  6001

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            December 2, 2013
                               ___________

Introduced  by  Sen.  GIPSON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

AN ACT to amend the public health law,  in  relation  to  funding  early
  intervention services

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

  Section 1. The public health law is amended by adding  a  new  section
2807-o to read as follows:
  S  2807-O.  EARLY  INTERVENTION  SERVICES  POOL.  1.  DEFINITIONS. THE
FOLLOWING WORDS OR PHRASES AS  USED  IN  THIS  SECTION  SHALL  HAVE  THE
FOLLOWING MEANINGS:
  (A)  "EARLY INTERVENTION SERVICES" SHALL MEAN SERVICES DELIVERED TO AN
ELIGIBLE CHILD, PURSUANT TO AN INDIVIDUALIZED FAMILY SERVICE PLAN  UNDER
THE EARLY INTERVENTION PROGRAM.
  (B)  "EARLY  INTERVENTION  PROGRAM"  SHALL MEAN THE EARLY INTERVENTION
PROGRAM FOR TODDLERS WITH DISABILITIES AND THEIR FAMILIES AS CREATED  BY
TITLE TWO-A OF ARTICLE TWENTY-FIVE OF THIS CHAPTER.
  (C)  "MUNICIPALITY"  SHALL  MEAN ANY COUNTY OUTSIDE OF THE CITY OF NEW
YORK OR THE CITY OF NEW YORK.
  2. GRANTS FOR EARLY INTERVENTION SERVICES. (A) THE COMMISSIONER SHALL,
FROM FUNDS ALLOCATED FOR SUCH PURPOSE UNDER PARAGRAPH (G) OF SUBDIVISION
SIX OF SECTION TWENTY-EIGHT HUNDRED SEVEN-S OF THIS ARTICLE, MAKE GRANTS
TO MUNICIPALITIES FOR THE DELIVERY OF EARLY INTERVENTION SERVICES.  SUCH
GRANTS  SHALL  BE  DEEMED  REIMBURSEMENT FROM THIRD PARTY PAYORS TO SUCH
MUNICIPALITIES AND THE STATE OF NEW YORK FOR THE PURPOSES OF  THE  EARLY
INTERVENTION PROGRAM.
  (B)  GRANTS  UNDER THIS SUBDIVISION SHALL BE AWARDED TO MUNICIPALITIES
BY THE COMMISSIONER. EACH MUNICIPALITY AND THE STATE OF NEW  YORK  SHALL
RECEIVE  A  SHARE OF SUCH GRANTS EQUAL TO ITS PROPORTIONATE SHARE OF THE
TOTAL APPROVED STATEWIDE DOLLARS NOT REIMBURSABLE BY THE MEDICAL ASSIST-
ANCE PROGRAM PAID TO PROVIDERS OF EARLY  INTERVENTION  SERVICES  BY  THE
STATE  AND  MUNICIPALITIES  ON ACCOUNT OF EARLY INTERVENTION SERVICES IN
THE LAST COMPLETE STATE FISCAL YEAR FOR WHICH SUCH DATA IS AVAILABLE.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03039-02-3

S. 6001                             2

  S 2. Subdivision 6 of section 2807-s  of  the  public  health  law  is
amended by adding two new paragraphs (g) and (h) to read as follows:
  (G)  A  FURTHER GROSS STATEWIDE AMOUNT FOR TWO THOUSAND FOURTEEN SHALL
BE FOUR HUNDRED MILLION DOLLARS.
  (H) THE AMOUNT SPECIFIED IN PARAGRAPH (G) OF THIS SUBDIVISION SHALL BE
ALLOCATED AMONG THE MUNICIPALITIES AND THE STATE OF NEW  YORK  BASED  ON
EACH  MUNICIPALITY'S  SHARE  AND THE STATE'S SHARE OF EARLY INTERVENTION
PROGRAM EXPENDITURES NOT REIMBURSABLE BY THE MEDICAL ASSISTANCE  PROGRAM
FOR THE LATEST TWELVE MONTH PERIOD FOR WHICH SUCH DATA IS AVAILABLE.
  S  3.  Subdivision  7  of  section  2807-s of the public health law is
amended by adding a new paragraph (d) to read as follows:
  (D) FUNDS SHALL BE ADDED TO THE FUNDS COLLECTED  BY  THE  COMMISSIONER
FOR DISTRIBUTION IN ACCORDANCE WITH SECTION TWENTY-EIGHT HUNDRED SEVEN-O
OF  THIS ARTICLE, IN THE FOLLOWING AMOUNT:  FOUR HUNDRED MILLION DOLLARS
FOR THE PERIOD JANUARY FIRST, TWO  THOUSAND  FOURTEEN  THROUGH  DECEMBER
THIRTY-FIRST, TWO THOUSAND FOURTEEN.
  S  4.  Subdivision  1  of  section  2557  of the public health law, as
amended by section 4 of part C of chapter 1 of  the  laws  of  2002,  is
amended to read as follows:
  1. The approved costs for an eligible child who receives an evaluation
and early intervention services pursuant to this title shall be a charge
upon  the  municipality wherein the eligible child resides or, where the
services are covered by the medical assistance program, upon the  social
services  district of fiscal responsibility with respect to those eligi-
ble children who are also eligible for medical assistance. All  approved
costs  shall be paid in the first instance and at least quarterly by the
appropriate governing body or officer of the municipality upon  vouchers
presented  and  audited  in  the same manner as the case of other claims
against the municipality. Notwithstanding the  insurance  law  or  regu-
lations thereunder relating to the permissible exclusion of payments for
services under governmental programs, no such exclusion shall apply with
respect  to  payments  made  pursuant to this title. Notwithstanding the
insurance law or any other law or agreement to  the  contrary,  benefits
under this title shall be considered secondary to any [plan of insurance
or]  state  government benefit program under which an eligible child may
have coverage. [Nothing in this section shall increase or enhance cover-
ages provided for within an insurance contract subject to the provisions
of this title.]
  S 5. Section 2557 of the public health law is amended by adding a  new
subdivision 4 to read as follows:
  4.  THE COMMISSIONER SHALL COLLECT DATA, BY MUNICIPALITY, ON THE EARLY
INTERVENTION PROGRAM AUTHORIZED UNDER THIS TITLE FOR PURPOSES OF IMPROV-
ING THE EFFICIENCY, COST EFFECTIVENESS, AND  QUALITY  OF  SUCH  PROGRAM.
SUCH MUNICIPALITY DATA COLLECTION SHALL INCLUDE BUT NOT BE LIMITED TO:
  (A) THE NUMBER AND AGES OF CHILDREN ENROLLED IN THE EARLY INTERVENTION
PROGRAM;
  (B)  THE  TOTAL NUMBER OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING A
SINGLE SERVICE, THE PERCENTAGE OF THOSE CHILDREN BY  SERVICE  TYPE,  AND
THE AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE;
  (C)  THE  TOTAL  NUMBER  OF CHILDREN, WITHIN A MUNICIPALITY, RECEIVING
MULTIPLE SERVICES, THE PERCENTAGE OF THOSE CHILDREN BY SERVICE TYPE, THE
AVERAGE FREQUENCY OF VISITS PER WEEK FOR SUCH SERVICE TYPE AND THE AVER-
AGE NUMBER OF SERVICE TYPES THAT EACH CHILD RECEIVES;
  (D) THE NUMBER OF NEW YORK STATE APPROVED AGENCIES,  INSTITUTIONS,  OR
ORGANIZATIONS PROVIDING EARLY INTERVENTION SERVICES BY SERVICE SPECIALTY
OR  SPECIALTIES  AND  THE  NUMBER OF NEW YORK STATE APPROVED INDEPENDENT

S. 6001                             3

PROVIDERS  OF  EARLY  INTERVENTION  SERVICES  BY  SERVICE  SPECIALTY  OR
SPECIALTIES;
  (E)  THE  NUMBER AND PERCENTAGE OF CHILDREN RECEIVING A SINGLE SERVICE
BY TYPE OF NEW YORK STATE APPROVED SERVICE PROVIDER, AND THE NUMBER  AND
PERCENTAGE  OF  CHILDREN RECEIVING MULTIPLE SERVICES BY TYPE OF NEW YORK
STATE APPROVED SERVICE PROVIDER;
  (F) THE OVERALL NUMBER OF NEW  YORK  STATE  APPROVED  EVALUATORS.  THE
NUMBER  OF APPROVED EVALUATORS WHO ALSO PROVIDE SERVICES TO EARLY INTER-
VENTION CHILDREN THEY HAVE EVALUATED;
  (G) THE NUMBER OF FAMILIES RECEIVING FAMILY SUPPORTIVE  SERVICES  SUCH
AS FAMILY TRAINING, COUNSELING, PARENT SUPPORT GROUPS, AND RESPITE;
  (H)  THE  TYPES  OF CLINICAL PRACTICE GUIDELINES, EVALUATION TOOLS AND
TESTING INSTRUMENTS USED BY MUNICIPALITIES TO ESTABLISH  ELIGIBILITY  OR
NEED FOR EARLY INTERVENTION SERVICES;
  (I)  BOTH SERVICE, COST AND PAYMENT OVERSIGHT MECHANISMS USED BY COUN-
TIES TO ENSURE QUALITY AND  EFFICIENT  DELIVERY  OF  EARLY  INTERVENTION
SERVICES;
  (J)  THE NUMBER OF CHILDREN THAT ARE COVERED BY THE MEDICAL ASSISTANCE
PROGRAM;
  (K) THE NUMBER OF CLAIMS SUBMITTED TO THE MEDICAL  ASSISTANCE  PROGRAM
BY  MUNICIPALITY. THE PERCENTAGE OF CLAIMS DENIED BY THE MEDICAL ASSIST-
ANCE PROGRAM. THE REASONS FOR THE DENIALS.
  THE COMMISSIONER SHALL COLLECT  AND  ANALYZE  SUCH  DATA  ELEMENTS  TO
DETERMINE  SERVICE  AND  UTILIZATION PATTERNS AND TO ENHANCE THE DEPART-
MENT'S ONGOING PROVISION OF PROGRAM OVERSIGHT AND GUIDANCE. IN ADDITION,
THE COMMISSIONER SHALL REPORT FOR THE PERIOD JULY  FIRST,  TWO  THOUSAND
FOURTEEN  TO  DECEMBER THIRTY-FIRST, TWO THOUSAND FOURTEEN, AND FOR EACH
CALENDAR YEAR THEREAFTER, TO THE GOVERNOR AND THE LEGISLATURE, BY  MARCH
FIRST OF EACH YEAR, THE INFORMATION AND ANALYSIS REQUIRED BY THIS SUBDI-
VISION.
  S  6.  Subdivision  2  of  section  2557  of the public health law, as
amended by section 9-a of part A of chapter 56 of the laws of  2012,  is
amended to read as follows:
  2. The department shall reimburse the approved costs paid by a munici-
pality  for the purposes of this title, other than those reimbursable by
the medical assistance program [or by third party payors], in an  amount
of fifty percent of the amount expended in accordance with the rules and
regulations   of  the  commissioner;  provided,  however,  that  in  the
discretion of the department and with the approval of  the  director  of
the  division of the budget, the department may reimburse municipalities
in an amount greater than fifty percent of  the  amount  expended.  Such
state reimbursement to the municipality shall not be paid prior to April
first  of  the  year in which the approved costs are paid by the munici-
pality, provided, however that, subject to the approval of the  director
of  the  budget,  the department may pay such state aid reimbursement to
the municipality prior to such date.
  S 7. The section heading of section 2559 of the public health law,  as
added by chapter 428 of the laws of 1992, is amended to read as follows:
  [Third   party  insurance  and  medical]  MEDICAL  assistance  program
payments.
  S 8.  Subdivision 3 of section 2559 of the public health law, as added
by chapter 428 of the laws of 1992,  paragraphs  (a),  (c)  and  (d)  as
amended  by  section  11 of part A of chapter 56 of the laws of 2012 and
paragraph (b) as further amended by section 104 of part A of chapter  62
of the laws of 2011, is amended to read as follows:

S. 6001                             4

  3. (a) Providers of evaluations and early intervention services, here-
inafter  collectively  referred  to in this subdivision as "provider" or
"providers", shall in the first  instance  and  where  applicable,  seek
payment  from  [all  third party payors including governmental agencies]
THE  MEDICAL  ASSISTANCE  PROGRAM prior to claiming payment from a given
municipality  for  evaluations  conducted  under  the  program  and  for
services rendered to eligible children, provided that, the obligation to
seek  payment shall not apply [to a payment from a third party payor who
is not prohibited from  applying  such  payment,  and  will  apply  such
payment, to an annual or lifetime limit specified in the insured's poli-
cy] WHERE THE INSURED IS NOT ELIGIBLE FOR MEDICAL ASSISTANCE PURSUANT TO
THE SOCIAL SERVICES LAW.
  (i)  Parents  shall  provide  the municipality and service coordinator
information on any insurance policy, plan or  contract  under  which  an
eligible child has coverage.
  (ii)  Parents shall provide the municipality and the service coordina-
tor with a written referral from a primary care provider  as  documenta-
tion,  for  eligible  children, of the medical necessity of early inter-
vention services.
  (iii) providers shall utilize the department's fiscal agent  and  data
system  for claiming payment for evaluations and services rendered under
the early intervention program.
  (b) [The commissioner, in consultation with the director of budget and
the superintendent of financial services, shall  promulgate  regulations
providing  public reimbursement for deductibles and copayments which are
imposed under an insurance policy or health benefit plan to  the  extent
that  such  deductibles  and  copayments  are applicable to early inter-
vention services.
  (c) Payments made for early intervention services under  an  insurance
policy  or  health  benefit plan, including payments made by the medical
assistance program or other governmental third party  payor,  which  are
provided  as  part  of  an  IFSP pursuant to section twenty-five hundred
forty-five of this title shall not be applied by  the  insurer  or  plan
administrator against any maximum lifetime or annual limits specified in
the  policy  or  health benefits plan, pursuant to section eleven of the
chapter of the laws of nineteen  hundred  ninety-two  which  added  this
title.
  (d)]  A  municipality, or its designee, and a provider shall be subro-
gated, to the extent of the expenditures by  such  municipality  or  for
early  intervention  services furnished to persons eligible for benefits
under this title, to any rights such person may have or be  entitled  to
from  [third  party  reimbursement]  THE MEDICAL ASSISTANCE PROGRAM. The
provider shall submit notice to the insurer or plan administrator of his
or her exercise of such right of subrogation upon the provider's assign-
ment as the early intervention service provider for the child. The right
of subrogation does not attach to benefits paid or provided  [under  any
health  insurance  policy  or  health benefits plan] prior to receipt of
written notice of the exercise of subrogation rights [by the insurer  or
plan  administrator providing such benefits]. NOTWITHSTANDING ANY INCON-
SISTENT PROVISION OF THIS TITLE, EXCEPT AS PROVIDED FOR HEREIN, NO THIRD
PARTY PAYOR OTHER THAN THE MEDICAL ASSISTANCE PROGRAM SHALL BE  REQUIRED
TO REIMBURSE FOR EARLY INTERVENTION SERVICES PROVIDED UNDER THIS TITLE.
  S  9.  This act shall take effect April 1, 2014; provided, however the
amendments to section 2807-s of the public health law made  by  sections
two  and  three  of  this  act  shall  not affect the expiration of such
section and shall be deemed to expire therewith.

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