senate Bill S6696A

2013-2014 Legislative Session

Provides for respiratory disease and obesity managements

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Archive: Last Bill Status - Passed Senate


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

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 16, 2014 referred to health
delivered to assembly
passed senate
ordered to third reading cal.1399
committee discharged and committed to rules
May 07, 2014 print number 6696a
amend (t) and recommit to health
Feb 28, 2014 referred to health

Votes

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Bill Amendments

Original
A (Active)
Original
A (Active)

Co-Sponsors

S6696 - Bill Details

See Assembly Version of this Bill:
A9186A
Current Committee:
Assembly Health
Law Section:
Public Health Law
Laws Affected:
Amd §§2111, 2411, 2599-b, 2599-c, 2500, 2505, 2505-a, 2515, 2515-a & 2522, Pub Health L

S6696 - Bill Texts

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Relates to combating the incidence of adult and childhood obesity and respiratory diseases; includes certain respiratory diseases and obesity in disease management demonstration programs; enacts provisions to reduce the incidence of certain respiratory diseases; expands the collection and reporting of data on obesity in the state; directs the health research science board to study obesity and respiratory diseases; expands ease of breast feeding in child day care centers and at work.

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BILL NUMBER:S6696

TITLE OF BILL: An act to amend the public health law, in relation to
including certain respiratory diseases and obesity within disease
management demonstration programs (Part A); to amend the public health
law, in relation to the reduction of emphysema, chronic bronchitis and
other chronic respiratory diseases in children (Part B); to amend the
public health law, in relation to directing the health research
science board to study respiratory diseases and obesity (Part C); to
amend the public health law, in relation to breastfeeding of infants
and the adolescent pregnancy nutrition counseling program (Part D); to
amend the education law, in relation to screening for childhood
obesity (Part E); to amend the education law, in relation to school
lunch periods (Part F); and to amend the insurance law and the public
health law, in relation to making actuarially appropriate reductions
in health insurance premiums in return for an enrollee's or insured's
participation in a qualified wellness program (Part G)

PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to
establish a comprehensive inter-disciplinary program to combat
childhood obesity. The incidence of childhood obesity is a rapidly
growing public health, social, and economic concern that is adversely
affecting the overall health and wellbeing of our next generation of
New Yorkers. In fact, acute and chronic adverse health conditions such
as diabetes, chronic coronary conditions, and respiratory illnesses
caused by obesity conditions is about to overtake those acute and
chronic adverse health conditions caused by smoking tobacco. This bill
attempts to better integrate current programs and laws that relate to
combating childhood obesity.

Further, this bill attempts to integrate activities that are currently
being conducted by state agencies and to encourage:

A) the Department of Health to better track areas of the state that
have high incidences of childhood obesity and encourage health care
facilities and health care providers to identify and treat such
conditions at an earlier time of a patient's life,

B) the Financial Services Department, to encourage health insurers and
their insureds to more actively participate in Wellness Programs that
combat the high incidence of adult and childhood obesity. Further,
altering the eating and exercise habits of parents can have positive
effects on the eating and exercise habits of their children,

C) the Education Department to more actively provide opportunities for
physical recreational activities to foster physical fitness and create
an environment so that students are more capable to learn because they
have "burned off" energy during recess,

D) better integrate the work of the Departments of Agriculture &
Markets, Education, and Health, and the Office of Children & Family
Services with activities conducted by local volunteer groups, health
care providers, local governments, schools and cooperative Extension
Services.

SUMMARY OF PROVISIONS: This bill is an inter-disciplinary approach to
address the high incidence of childhood obesity in New York State.


Further, this bill amends many sections of law, so it is broken down
into Parts A through G, depending on the laws to be amended.

PART A:

Section 1: Amends Public Health Law section 2111 to expand the scope
of disease management demonstration programs administered by DOH to
enhance the quality and cost-effectiveness of care rendered to
Medicaid-eligible persons who do not participate in Medicaid Managed
Care who have chronic health problems. Under current law,
demonstration programs can include chronic conditions related to
congestive heart failure, chronic obstructive pulmonary disease,
asthma and diabetes. This provision expands the scope of demonstration
programs to include emphysema, obesity, chronic bronchitis, and other
chronic respiratory diseases.

PART B:

Section 1: Amends Public Health Law section 2599-b to expand the scope
of programs administered by DOH to reduce the incidence and prevalence
of obesity in children and adolescents, especially among populations
with high rates of obesity. Under current law, the program looks to
address obesity related health complications such as diabetes, heart
disease, cancer, osteoarthritis, and asthma. This bill would expand
such programs to include obesity-related health complications such as
chronic bronchitis, and other chronic respiratory diseases.

In addition a new paragraph (h) is added to encourage DOH to
coordinate with the Education Department, Office of Temporary and
Disability Assistance, Office of Children and Family Services, and
other federal, state, and local agencies to incorporate strategies to
curtail the incidence of asthma, and chronic respiratory diseases to
enable adults and children to safely increase physical activity to
help curb the incidence of obesity.

Section 2: Amends Public Health Law section 2599-c that relates to the
Department's role in encouraging more school-based childhood obesity
prevention and physical activity programs. This bill adds that the
Department in advancing school-based childhood obesity prevention and
physical activity programs should cooperate with the Commissioners of
Agriculture & Markets and Education, and county boards of cooperative
extension.

PART C:

Section 1: Amends Public Health Law section 2411 which relates to the
powers and duties of the Commissioner. This provision authorizes the
Commissioner to act in an advisory and supervisory capacity with
regard to the Health Research Science Board as it relates to childhood
obesity, asthma, and chronic bronchitis or other respiratory diseases.
Further it expands the jurisdiction of such Board to research issues
related to childhood obesity, asthma, and other respiratory diseases
in addition to already being authorized to research breast, prostate
or testicular cancer.


Section 2: Amends Public Health Law section 2500 (1) which relates to
the Commissioner's duties as it relates to maternal and child health
to also include childhood obesity.

PART D:

Section 1: Amends Public Health Law section 2505-a to add child day
care facilities to the list of facilities that must post the
"statement of rights of breast feeding mothers". The goal of this
provision is to disseminate the statement of rights of breastfeeding
mothers to places where such mothers may frequent. Studies have shown
that encouraging the breast feeding of children reduces the risk that
such infants become obese later on in life.

Section 2: Amends Public Health Law section 2505, which relates to the
general powers of the Commissioner to regulate the collection, storage
and distribution of human breast milk. This provision authorizes the
Commissioner to conduct educational activities to encourage and
facilitate employers and child day care centers to establish
environments that do not discourage the practice of breast feeding.

Section 3: Amends Public Health Law section 2515 (2) that relates to
Adolescent Pregnancy Prevention and Services Program to add to
"services for eligible adolescents" vocational and education
counseling on pregnancy and child nutrition counseling for expectant
mothers to help curtail the incidence of childhood obesity.

Section 4: Amends Public Health Law section 2515-a(2) that relates to
the administration of community service project plans. The purpose of
these demonstration plans is to develop new methodologies to advance
the provision of health care that reduces adolescent pregnancy and
provide services to assist teenage mothers. These demonstration
programs tend to be located in geographical areas where there is a
high incidence of infant. mortality and low income families. This
provision expands the demonstration program areas to also include
geographical areas that have low birth weight babies or childhood
obesity.

Section 5: Amends Public Health Law section 2522 to empower the Health
Department to provide funds, if it deems appropriate, to finance
health and nutritional education and services to both parents
regarding childhood and adult obesity and asthma, and the prevention
or mitigation thereof.

PART E:

Section 1: Amends Education Law section 901 which relates to school
health services to be provided. This section expands the types of
services that may be provided by school health services to include
examining students for the existence, in addition to diseases or
disabilities, to include childhood obesity as defined pursuant to
existing Education Law standards contained in section 904.

Section 2: Amends Education Law section 918 (4) and (5) which relates
to the formation of school district nutrition advisory committees.
Under this provision, such advisory committees can study and make
recommendations on current nutritional policies of the school district


to reduce the incidence of childhood obesity. Further, such advisory
committees can make recommendations on educational information that
can be provided to parents and guardians of students regarding healthy
nutrition and health risks associated with asthma, chronic bronchitis,
and other chronic respiratory diseases. Provided further, make
recommendations to teachers and other staff as to the dangers of
childhood obesity.

Section 6: This Part E shall take effect 2 years after it shall have
become law.

PART F:

Section 1: Amends Education Law section 813 to ensure that during a
primary and secondary student's lunch period that ample time is
devoted so that such student can consume his lunch and have time to
engage in physical exercise or recreation.

PART G:

Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer
an actuarially appropriate premium discount or other benefits or
enhancements to those individuals that participate in a qualified
wellness program. Such qualified wellness program must be approved by
the Financial Services Department. Further, such qualified Wellness
program can be either a risk management system that identifies at-risk
populations or any other systematic program or course of medical
conduct which helps to promote physical and mental fitness, helms to
prevent or mitigate acute or chronic sickness, disease or pain, or
which minimizes adverse health consequences due to lifestyle. To
protect all covered persons, the insurer or HMO shall not require
specific medical outcomes as a result of an insured's adherence to the
approved wellness program.

Section 2: Amends Insurance Law section 3239 which relates to Wellness
Programs that can be sponsored by a health insurance plan. This
provision expands the kinds of Wellness Programs that are covered
under the Insurance Law to include substance or alcohol abuse
cessation programs and programs to manage and cope with chronic pain.
In addition, the bill expands and provides for the full or partial
reimbursement for the cost of participating in programs that are
already currently authorized under this provision of the law, such as
programs related to stress and or hypertension, worker injury
prevention and nutrition education.

Section 3: Amends Insurance Law section 4235(h) to permit insurers and
HMOs that offer accident and health insurance (large group policies)
to offer an actuarially appropriate premium discount or other benefits
or enhancements to those persons that participate in a qualified
wellness program approved by the Superintendent,

Section 4: Amends Insurance Law section 4317 to permit Article 43
insurers and HMOs that offer individual or small group contracts to
offer, subject to the approval of the Superintendent, an actuarially
appropriate premium discount or other enhancements to those persons
that participate in a qualified wellness program.


Section 5: Amends insurance Law section 4326 to permit insurers and
HMOs that offer the subsidized "Healthy New York" policies to offer an
actuarially appropriate premium discount or other enhancements to
those persons that participate in a qualified wellness program.

Section 6: Amends Public Health Law section 4405 to provide for the
same actuarially appropriate reduction in HMO health policies for
those who participate in a Qualified wellness program.

JUSTIFICATION: The growing prevalence of overweight and obese
children is a crisis that is facing the entire nation. Obesity related
health care expenditures in New York are some of the highest in the
nation. Further, contrary to the lower prevalence of obesity among
adults, children in New York are more likely to be obese or overweight
when compared to national trends. Obesity and overweight conditions in
individuals are leading to higher incidences of life threatening
conditions and substantial economic costs both to the State of New
York for health care costs and to employers in lost work time and
higher health care costs. Obesity in children tends to manifest itself
more widely among poorer children and children whose parents have
lower education levels.

The rising incidence of childhood obesity is a serious medical problem
that continues to grow, especially among poorer and minority
communities. Further, obesity is known to cause or exacerbate a number
of serious chronic medical disorders including hypertension,
dyslipidemia, cardiovascular disease, diabetes, and respiratory
dysfunction. Nearly 80% of patients with diabetes mellitus are obese,
while nearly 70% of diagnosed cases of cardiovascular disease are
related to obesity. Obesity ranks only second to smoking as a
preventable cause of death. Unfortunately, preventable deaths caused
by obesity conditions is rapidly approaching and will surpass those
deaths caused by smoking tobacco.

While the high prevalence of obesity and overweight conditions is an
important public health concern when it affects adults. It should be
of heightened concern that this adult affliction is now becoming more
common among children. When obesity conditions afflict children this
poses, significant quality of life detriments to such persons, reduces
the productivity of such individuals over a longer time of their life,
and hastens the onset of many chronic conditions that can hurt the
quality of life of such persons and their families.

The provisions of this bill are derived from a report by the
Independent Democratic Conference entitled "Childhood Obesity:
Mitigation and Prevention in the State of New York". This report
outlines the trends of the increasing incidence of childhood obesity,
some of the causes of this increase, and suggested courses of action
that can be taken to help reduce this ever increasing public health
problem. It is important for state agencies such as the Departments of
Health, Education, Agriculture & Markets, and Financial Services, the
Office of Children and Family Services coordinate their current
activities to curb this problem. Further, once New York's state
agencies have a more coordinated approach to curb childhood obesity,
then other public stakeholders such as school educators and BOCES can
combine forces with such state agencies and with private stakeholders
such as health care providers, health care facilities, child day care


centers, insurers, and community groups to provide a coordinated way
to address this problem.

PRIOR LEGISLATIVE HISTORY: This bill has some similar elements as S.
2374-A / A. 5322-A (Klein/Crespo).

EFFECTIVE DATE: See relevant sections at the end of each Part of this
bill.

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

                                  6696

                            I N  S E N A T E

                            February 28, 2014
                               ___________

Introduced  by  Sens.  KLEIN, CARLUCCI, SAVINO -- 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 including  certain
  respiratory  diseases  and  obesity  within  disease management demon-
  stration programs (Part  A);  to  amend  the  public  health  law,  in
  relation  to  the reduction of emphysema, chronic bronchitis and other
  chronic respiratory diseases in children (Part B); to amend the public
  health law, in relation to directing the health research science board
  to study respiratory diseases and  obesity  (Part  C);  to  amend  the
  public  health  law,  in  relation to breastfeeding of infants and the
  adolescent pregnancy nutrition counseling program (Part D);  to  amend
  the  education  law,  in  relation  to screening for childhood obesity
  (Part E); to amend the education law,  in  relation  to  school  lunch
  periods (Part F); and to amend the insurance law and the public health
  law,  in  relation  to  making  actuarially  appropriate reductions in
  health insurance premiums in return for  an  enrollee's  or  insured's
  participation in a qualified wellness program (Part G)

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

  Section 1.  This act enacts into law major components  of  legislation
which  combat  the  incidence of adult and child obesity and respiratory
diseases.  Each component is wholly contained within a  Part  identified
as  Parts  A through G. The effective date for each particular provision
contained within such Part is set forth in  the  last  section  of  such
Part.  Any  provision  in any section contained within a Part, including
the effective date of the Part, which makes a reference to a section "of
this act", when used in connection with that particular component, shall
be deemed to mean and refer to the corresponding section of the Part  in
which  it  is  found.   Section three of this act sets forth the general
effective date of this act.

                                 PART A

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14161-02-4

S. 6696                             2

  Section 1. Subdivisions 2 and 4 of section 2111 of the  public  health
law, as added by section 21 of part C of chapter 58 of the laws of 2004,
are amended to read as follows:
  2.  The  department  shall establish the criteria by which individuals
will be identified as  eligible  for  enrollment  in  the  demonstration
programs.    Persons  eligible  for enrollment in the disease management
demonstration program shall  be  limited  to  individuals  who:  receive
medical  assistance  pursuant  to  title  eleven  of article five of the
social services law and may be eligible for benefits pursuant  to  title
18 of the social security act (Medicare); are not enrolled in a Medicaid
managed  care  plan,  including  individuals who are not required or not
eligible to participate in Medicaid managed care  programs  pursuant  to
section three hundred sixty-four-j of the social services law; are diag-
nosed  with  chronic  health  problems as may be specified by the entity
undertaking the demonstration program, including, but not limited to one
or more of the following: congestive heart failure, chronic  obstructive
pulmonary  disease, asthma, EMPHYSEMA, CHRONIC BRONCHITIS, OTHER CHRONIC
RESPIRATORY DISEASES, diabetes, ADULT AND CHILDHOOD  OBESITY,  or  other
chronic health conditions as may be specified by the department; or have
experienced  or are likely to experience one or more hospitalizations or
are otherwise expected to incur excessive costs and high utilization  of
health care services.
  4.  The  demonstration program shall offer evidence-based services and
interventions designed to ensure that the enrollees receive high  quali-
ty, preventative and cost-effective care, aimed at reducing the necessi-
ty  for hospitalization or emergency room care or at reducing lengths of
stay when hospitalization is necessary. The  demonstration  program  may
include  screening  of  eligible enrollees, developing an individualized
care management plan for  each  enrollee  and  implementing  that  plan.
Disease management demonstration programs that utilize information tech-
nology  systems  that allow for continuous application of evidence-based
guidelines to medical assistance claims data and other available data to
identify specific instances in which clinical interventions  are  justi-
fied  and communicate indicated interventions to physicians, health care
providers and/or patients, and monitor physician and health care provid-
er response to such interventions, shall have the enrollees,  or  groups
of enrollees, approved by the department for participation. The services
provided  by  the  demonstration  program as part of the care management
plan may include, but are not limited to, case management, social  work,
individualized  health  counselors, multi-behavioral goals plans, claims
data management, health and self-care education, drug therapy management
and oversight, personal emergency response systems and other  monitoring
technologies,  SYSTEMATIC CHRONIC HEALTH CONDITIONS IDENTIFIED FOR MONI-
TORING, telehealth services and similar services designed to improve the
quality and cost-effectiveness of health care services.
  S 2. This act shall take effect immediately.

                                 PART B

  Section 1.  Section 2599-b of the public health  law,  as  amended  by
section  88  of  part B of chapter 58 of the laws of 2005, is amended to
read as follows:
  S 2599-b. Program development.  1. The program shall  be  designed  to
prevent  and  reduce the incidence and prevalence of obesity in children
and adolescents, especially among populations with high rates of obesity
and obesity-related health complications including, but not limited  to,

S. 6696                             3

diabetes,  heart  disease,  cancer,  osteoarthritis,  asthma, EMPHYSEMA,
CHRONIC BRONCHITIS, OTHER CHRONIC RESPIRATORY DISEASES and other  condi-
tions.  The  program  shall  use recommendations and goals of the United
States  departments  of  agriculture  and health and human services, the
surgeon general and centers for disease control AND PREVENTION in devel-
oping and implementing guidelines for nutrition education  and  physical
activity projects as part of obesity prevention efforts. The content and
implementation  of  the  program shall stress the benefits of choosing a
balanced, healthful diet from the many options available  to  consumers,
without  specifically  targeting  the elimination of any particular food
group, food product or food-related industry.
  2. The childhood obesity prevention program shall include, but not  be
limited to:
  (a)  developing  media health promotion campaigns targeted to children
and adolescents and their parents and caregivers that emphasize increas-
ing consumption of low-calorie, high-nutrient foods, decreasing consump-
tion of high-calorie, low-nutrient foods and increasing physical  activ-
ity designed to prevent or reduce obesity;
  (b)  establishing  school-based childhood obesity prevention nutrition
education and physical activity programs including programs described in
section twenty-five hundred ninety-nine-c of this article,  as  well  as
other  programs  with linkages to physical and health education courses,
and which utilize the school health index of  the  National  Center  for
Chronic  Disease  Prevention  and  Health  Promotion or other recognized
school health assessment PURSUANT TO ARTICLE NINETEEN OF  THE  EDUCATION
LAW;
  (c)  establishing  community-based childhood obesity prevention nutri-
tion education and physical activity programs including  programs  which
involve  parents  and caregivers, and which encourage communities, fami-
lies, child care and other settings to provide safe and  adequate  space
and  time for physical activity and encourage a healthy diet, AND CAN BE
IN COORDINATION WITH COUNTY COOPERATIVE EXTENSION  PROGRAMS  ESTABLISHED
PURSUANT TO SECTION TWO HUNDRED TWENTY-FOUR-B OF THE COUNTY LAW;
  (d)  coordinating  with  the state education department, department of
agriculture and markets, office of parks, recreation and historic  pres-
ervation, office of temporary and disability assistance, office of chil-
dren  and family services and other federal, state and local agencies to
incorporate strategies to prevent  and  reduce  childhood  obesity  into
government food assistance, health, education and recreation programs;
  (e)  sponsoring  periodic  conferences  or  meetings to bring together
experts in nutrition, exercise, public health, mental health, education,
parenting, media, food marketing, food security, agriculture,  community
planning  and  other  disciplines to examine societal-based solutions to
the problem of childhood obesity and issue  guidelines  and  recommenda-
tions for New York state policy and programs;
  (f)  developing training programs for medical and other health profes-
sionals to teach practical skills in nutrition and exercise education to
children and their parents and caregivers; [and]
  (g) developing screening programs in  coordination  with  health  care
providers and institutions including but not limited to day care centers
and  schools  for  overweight  and obesity for children aged two through
eighteen years, using body mass index  (BMI)  appropriate  for  age  and
gender,  and notification, in a manner protecting the confidentiality of
such children and their families, of parents of BMI status, and explana-
tion of the consequences of such status, including  recommended  actions
parents  may  need to take and information about resources and referrals

S. 6696                             4

available to families to enhance  nutrition  and  physical  activity  to
reduce and prevent obesity[.]; AND
  (H)  COORDINATING  WITH  THE EDUCATION DEPARTMENT, OFFICE OF TEMPORARY
AND DISABILITY ASSISTANCE, OFFICE OF CHILDREN AND  FAMILY  SERVICES  AND
OTHER  FEDERAL,  STATE  AND  LOCAL AGENCIES TO INCORPORATE STRATEGIES TO
CURTAIL THE INCIDENCE OF ASTHMA, CHRONIC BRONCHITIS  AND  OTHER  CHRONIC
RESPIRATORY  DISEASES  TO  ENABLE ADULTS AND CHILDREN TO SAFELY INCREASE
PHYSICAL ACTIVITY TO HELP CURB THE INCIDENCE OF OBESITY.
  3. The department, IN COOPERATION WITH THE EDUCATION DEPARTMENT, shall
periodically collect and analyze information from  schools,  health  and
nutrition  programs  and  other  sources  to determine the prevalence of
childhood obesity in New York state, and  to  evaluate,  to  the  extent
possible, the effectiveness of the childhood obesity prevention program.
  S 2. The opening paragraph of section 2599-c of the public health law,
as amended by section 88 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
  The  commissioner,  IN COOPERATION WITH THE COMMISSIONERS OF EDUCATION
AND AGRICULTURE AND MARKETS, AND COUNTY BOARDS OF COOPERATIVE EXTENSION,
shall encourage the  establishment  of  school-based  childhood  obesity
prevention and physical activity programs that promote:
  S 3. This act shall take effect immediately.

                                 PART C

  Section  1.    Paragraphs (a), (b) and (c) of subdivision 1 of section
2411 of the public health law, as amended by chapter 219 of the laws  of
1997, are amended to read as follows:
  (a)  Survey  state  agencies, boards, programs and other state govern-
mental entities to assess what, if any, relevant data  has  been  or  is
being  collected  which  may be of use to researchers engaged in breast,
prostate or testicular cancer research, OR ADULT AND CHILDHOOD  OBESITY,
ASTHMA,   CHRONIC   BRONCHITIS  OR  OTHER  CHRONIC  RESPIRATORY  DISEASE
RESEARCH;
  (b) Consistent with the survey conducted pursuant to paragraph (a)  of
this  subdivision,  compile  a  list of data collected by state agencies
which may be of assistance to researchers engaged in breast, prostate or
testicular cancer research as established in section twenty-four hundred
twelve of this title, AND ADULT AND CHILDHOOD OBESITY,  ASTHMA,  CHRONIC
BRONCHITIS OR OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
  (c)  Consult  with the Centers for Disease Control and Prevention, the
National Institutes of Health, the Federal Agency For Health Care Policy
and Research, the National Academy of Sciences and  other  organizations
or  entities  which  may  be involved in cancer research to solicit both
information regarding breast, prostate and  testicular  cancer  research
projects, AND ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR
OTHER  CHRONIC  RESPIRATORY DISEASE RESEARCH PROJECTS that are currently
being conducted and recommendations for future research projects;
  S 2. Subdivision 1 of section  2500  of  the  public  health  law,  as
amended  by  chapter  822  of  the  laws  of 1987, is amended to read as
follows:
  1. The commissioner shall act in an advisory and supervisory capacity,
in matters pertaining to the safeguarding of motherhood, the  prevention
of  maternal,  perinatal,  infant and child mortality, the prevention of
diseases, low birth weight, CHILDHOOD OBESITY, and defects of  childhood
and the promotion of maternal, prenatal and child health, including care
in  hospitals,  and shall administer such services bearing on the health

S. 6696                             5

of mothers and children for which funds are or shall hereafter  be  made
available.
  S 3. This act shall take effect immediately.

                                 PART D

  Section 1.  Section 2505-a of the public health law, as added by chap-
ter 292 of the laws of 2009, is amended to read as follows:
  S  2505-a.  Rights of breastfeeding mothers. 1. The principles enunci-
ated in subdivision three of this section are declared to be the  public
policy  of  the  state  and  a copy of such statement of rights shall be
posted conspicuously in a public place  in  each  maternal  health  care
facility  AND  CHILD  DAY CARE FACILITY.   For purposes of this section,
"maternal health care provider" means a  physician,  midwife,  or  other
authorized practitioner attending a pregnant woman; and "maternal health
care  facility"  includes  hospitals  and  freestanding birthing centers
providing perinatal services in accordance with article twenty-eight  of
this chapter and applicable regulations.
  2. The commissioner shall make available to every maternal health care
provider [and], maternal health care facility AND CHILD DAY CARE FACILI-
TY,  on  the  health department's website for the purpose of health care
facilities to include such rights in the maternity  information  leaflet
as  described in section twenty-eight hundred three-j of this chapter, a
copy of the statement of rights provided in subdivision  three  of  this
section  in the top six languages other than English spoken in the state
according to the latest available data from the U.S. Bureau  of  Census,
and  shall adopt any rules and regulations necessary to ensure that such
patients are treated in accordance with the provisions  of  such  state-
ment.
  3. The statement of rights shall consist of the following:
                 "Breastfeeding Mothers' Bill of Rights"
  Choosing  the  way you will feed your new baby is one of the important
decisions you will make in preparing for your infant's arrival.  Doctors
agree  that  for most women breastfeeding is the safest and most healthy
choice. It is your right to be informed about the  benefits  of  breast-
feeding  and  have your health care provider [and], maternal health care
facility AND CHILD DAY CARE FACILITY encourage and  support  breastfeed-
ing.  You  have  the  right to make your own choice about breastfeeding.
Whether you choose to breastfeed or not you  have  the  following  basic
rights  regardless  of  your race, creed, national origin, sexual orien-
tation, gender identity or expression, or source  of  payment  for  your
health  care.  Maternal  health care facilities have a responsibility to
ensure that you understand these rights. They must provide this informa-
tion clearly for you and must provide an interpreter if necessary. These
rights may only be limited in cases where your health or the  health  of
your  baby requires it. If any of the following things are not medically
right for you or your baby, you should be fully informed  of  the  facts
and be consulted.
(1)  Before  You  Deliver,  if  you attend prenatal childbirth education
classes provided by the maternal health care facility and  all  hospital
clinics and diagnostic and treatment centers providing prenatal services
in  accordance with article 28 of the public health law you must receive
the breastfeeding mothers' bill of rights.  Each  maternal  health  care
facility  shall provide the maternity information leaflet, including the
Breastfeeding Mothers' Bill of Rights, in accordance with section  twen-
ty-eight  hundred  three-i  of  this  chapter  to each patient or to the

S. 6696                             6

appointed personal representative at the time of prebooking or  time  of
admission  to a maternal health care facility. Each maternal health care
provider shall give a copy of the Breastfeeding Mothers' Bill of  Rights
to each patient at or prior to the medically appropriate time.
  You  have  the  right  to  complete  information about the benefits of
breastfeeding for yourself and your baby. This will  help  you  make  an
informed choice on how to feed your baby.
  You  have  the right to receive information that is free of commercial
interests and includes:
  *  How  breastfeeding  benefits  you  and  your  baby   nutritionally,
medically and emotionally;
  * How to prepare yourself for breastfeeding;
  * How to understand some of the problems you may face and how to solve
them.
(2) In The Maternal Health Care Facility:
  * You have the right to have your baby stay with you right after birth
whether you deliver vaginally or by cesarean section. You have the right
to begin breastfeeding within one hour after birth.
  *  You  have  the right to have someone trained to help you in breast-
feeding give you information and help you when you need it.
  * You have the right to have your baby not receive any bottle  feeding
or pacifiers.
  *  You  have the right to know about and refuse any drugs that may dry
up your milk.
  * You have the right to have your baby in your room with you 24  hours
a day.
  * You have the right to breastfeed your baby at any time day or night.
  *  You  have the right to know if your doctor or your baby's pediatri-
cian is advising against breastfeeding before any feeding decisions  are
made.
  *  You have the right to have a sign on your baby's crib clearly stat-
ing that your baby is breastfeeding and that no bottle  feeding  of  any
type is to be offered.
  *  You  have  the  right to receive full information about how you are
doing with breastfeeding and get help on how to improve.
  * You have the right to breastfeed your baby in the neonatal intensive
care unit. If nursing is not possible, every attempt  will  be  made  to
have your baby receive your pumped or expressed milk.
  * If you, or your baby, are re-hospitalized in a maternal care facili-
ty  after the initial delivery stay, the hospital will make every effort
to continue to support breastfeeding, to provide hospital grade electric
pumps and rooming in facilities.
  * You have the right to have help from someone  specially  trained  in
breastfeeding  support  and  expressing  breast  milk  if  your baby has
special needs.
  * You have the right to have a family member or friend receive breast-
feeding information from a staff member if you request it.
(3) When You Leave The Maternal Health Care Facility:
  * You have the right to  printed  breastfeeding  information  free  of
commercial material.
  * You have the right, unless specifically requested by you, and avail-
able  at  the  facility,  to  be  discharged  from  the facility without
discharge packs containing infant formula,  or  formula  coupons  unless
ordered by your baby's health care provider.

S. 6696                             7

  *  You have the right to get information about breastfeeding resources
in your community including information on availability of breastfeeding
consultants, support groups and breast pumps.
  * You have the right to have the facility give you information to help
choose a medical provider for your baby and understand the importance of
a follow-up appointment.
  *  You  have  the right to receive information about safely collecting
and storing your breast milk.
  * You have the right to breastfeed your baby in any  location,  public
or  private, where you are otherwise authorized to be. Complaints can be
directed to the New York State Division of Human Rights.
  * YOU HAVE A RIGHT TO BREASTFEED YOUR BABY AT YOUR PLACE OF EMPLOYMENT
OR CHILD DAY CARE CENTER IN AN  ENVIRONMENT  THAT  DOES  NOT  DISCOURAGE
BREASTFEEDING OR THE PROVISION OF BREAST MILK.
  All  the  above  are your rights. If the maternal health care facility
does not honor these rights you can seek help by contacting the New York
state department of health  or  by  contacting  the  hospital  complaint
hotline or via email.
  4.  The  commissioner  shall  make regulations reasonably necessary to
implement this section.
  S 2. Section 2505 of the public health law, as added by chapter 479 of
the laws of 1980, is amended to read as follows:
  S 2505. Human  breast  milk;  collection,  storage  and  distribution;
general  powers  of  the  commissioner.    The  commissioner  is  hereby
empowered to:
  (a) adopt regulations and guidelines including,  but  not  limited  to
donor  standards,  methods of collection, and standards for storage, and
distribution of human breast milk;
  (b) conduct educational activities to inform  the  public  and  health
care  providers  of  the  availability  of human breast milk for infants
determined to require such milk and to inform potential  donors  of  the
opportunities for proper donation;
  (c) CONDUCT EDUCATIONAL ACTIVITIES TO ENCOURAGE AND FACILITATE EMPLOY-
ERS  AND  CHILD  DAY  CARE CENTERS TO ESTABLISH ENVIRONMENTS THAT DO NOT
DISCOURAGE BREASTFEEDING AND THE PROVISION OF BREAST MILK. SUCH ENVIRON-
MENTS MAY INCLUDE SANITARY LOCATIONS FOR BREASTFEEDING AND REFRIGERATORS
TO ASSIST IN BREASTFEEDING AND  FEEDING  BABIES  WITH  EXPRESSED  BREAST
MILK; AND
  (D)  establish  rules  and regulations to effectuate the provisions of
this section.
  S 3. Subdivision 2 of section 2515 of the public health law, as  added
by section 20 of part A of chapter 58 of the laws of 2008, is amended to
read as follows:
  2. "Services for eligible adolescents" means those services, including
but  not  limited  to: vocational and educational counseling, job skills
training, family life and parenting education, life skills  development,
coordination, case management, primary preventive health care, PREGNANCY
AND  CHILD  NUTRITION COUNSELING FOR EXPECTANT MOTHERS TO CURB THE INCI-
DENCE OF CHILDHOOD OBESITY, family  planning,  social  and  recreational
programs, child care, outreach and advocacy, follow-up on service utili-
zation, crisis intervention, and efforts to stimulate community interest
and involvement.
  S  4.  Paragraph  (c) of subdivision 2 of section 2515-a of the public
health law, as added by section 20 of part A of chapter 58 of  the  laws
of 2008, is amended to read as follows:

S. 6696                             8

  (c)  serve  a geographic area where the incidence of infant mortality,
LOW BIRTH WEIGHT INFANTS, CHILDHOOD OBESITY and the prevalence  of  low-
income  families are high and where the availability or accessibility of
services for eligible adolescents is low;
  S  5.  Subdivision  (b)  of  section 2522 of the public health law, as
amended by chapter 484 of the laws of 2009, is amended and a new  subdi-
vision (e-1) is added to read as follows:
  (b) promotion of community awareness of the benefits TO THE MOTHER AND
CHILD of preconception health and early and continuous prenatal care;
  (E-1)  HEALTH AND NUTRITIONAL EDUCATION AND SERVICES FOR BOTH PARENTS,
REGARDING CHILDHOOD AND ADULT OBESITY AND ASTHMA, AND THE PREVENTION  OR
MITIGATION THEREOF;
  S 6. This act shall take effect immediately.

                                 PART E

  Section 1. Section 901 of the education law, as amended by chapter 477
of  the laws of 2004, subdivision 1 as amended by section 57 of part A-1
of chapter 58 of the laws of 2006, is amended to read as follows:
  S 901. School  health  services  to  be  provided.  1.  School  health
services,  as  defined  in  subdivision  two  of  this section, shall be
provided by each school district for all students attending  the  public
schools in this state, except in the city school district of the city of
New  York,  as  provided  in  this article. School health services shall
include the services of a  registered  professional  nurse,  if  one  is
employed,  and  shall  also  include such services as may be rendered as
provided in this article in examining  students  for  the  existence  of
disease  or disability, OR MAY INCLUDE SERVICES RELATED TO EXAMINING FOR
CHILDHOOD OBESITY BASED UPON THE CALCULATION OF EACH STUDENT'S BODY MASS
INDEX AND WEIGHT STATUS CATEGORY PURSUANT TO SECTION NINE  HUNDRED  FOUR
OF THIS ARTICLE, and in testing the eyes and ears of such students.
  2.  School health services for the purposes of this article shall mean
the several procedures, including, but not limited to, medical  examina-
tions,  dental  inspection and/or screening, scoliosis screening, vision
screening [and], audiometer tests, AND CHILDHOOD OBESITY AS MEASURED  BY
BODY  MASS  INDEX  AND WEIGHT STATUS CATEGORY, designed to determine the
health status of the child;  to  inform  parents  or  other  persons  in
parental  relation  to  the child, pupils and teachers of the individual
child's health condition subject to federal  and  state  confidentiality
laws; to guide parents, children and teachers in procedures for prevent-
ing  and correcting defects [and], diseases AND CHILDHOOD OBESITY CONDI-
TIONS; to instruct the school personnel in procedures to take in case of
accident or  illness;  to  survey  and  make  necessary  recommendations
concerning  the  health  and safety aspects of school facilities and the
provision of health information.
  S 2. Subdivisions 4 and 5 of section 918  of  the  education  law,  as
added  by  chapter  493  of  the  laws  of  2004, are amended to read as
follows:
  4. The committee is encouraged to study AND  MAKE  RECOMMENDATIONS  ON
all  facets  of the current nutritional policies of the district includ-
ing, but not limited to, the goals of the district to promote health and
proper nutrition, REDUCE THE INCIDENCE  OF  CHILDHOOD  OBESITY,  vending
machine  sales,  menu  criteria, educational curriculum teaching healthy
nutrition, AND educational information provided to parents or  guardians
regarding  healthy nutrition and the health risks associated with obesi-
ty, ASTHMA, CHRONIC BRONCHITIS AND OTHER CHRONIC  RESPIRATORY  DISEASES.

S. 6696                             9

PROVIDED,  FURTHER,  THE COMMITTEE MAY PROVIDE INFORMATION TO PERSONS IN
PARENTAL RELATION ON opportunities offered to parents  or  guardians  to
encourage  healthier  eating  habits  to  students,  and  the  education
provided  to  teachers  and  other staff as to the importance of healthy
nutrition AND ABOUT THE DANGERS OF CHILDHOOD OBESITY.   In addition  the
committee   shall   consider  recommendations  and  practices  of  other
districts and nutrition studies.
  5. The committee is encouraged to report periodically to the  district
regarding practices that will educate teachers, parents or guardians and
children  about  healthy nutrition and raise awareness of the dangers of
CHILDHOOD obesity, ASTHMA, CHRONIC BRONCHITIS AND OTHER CHRONIC  RESPIR-
ATORY  DISEASES.  The committee is encouraged also to provide any parent
teacher associations in the district with such findings and  recommenda-
tions.
  S 3. This act shall take effect two years after it shall have become a
law.

                                 PART F

  Section  1.  Section 813 of the education law, as added by chapter 296
of the laws of 1994, is amended to read as follows:
  S 813. School lunch period; scheduling.  Each school shall schedule  a
reasonable time DURING EACH SCHOOL DAY for each full day pupil attending
pre-kindergarten  through  grade twelve WITH AMPLE TIME to consume lunch
AND TO ENGAGE IN PHYSICAL EXERCISE OR RECREATION.
  S 2. This act shall take effect immediately.

                                 PART G

  Section 1. Section 3231 of the insurance law, as added by chapter  501
of the laws of 1992, is amended by adding a new subsection (c-1) to read
as follows:
  (C-1)  SUBJECT  TO  THE  APPROVAL OF THE SUPERINTENDENT, AN INSURER OR
HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL  OR  GROUP  HEALTH
INSURANCE POLICY PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS

S. 6696                            10

PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
ARTICLE; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 2. Subsections (b) and (c) of section 3239 of the insurance law,  as
added  by  chapter  592  of  the  laws  of  2008,  paragraphs 6 and 7 of
subsection  (b)  and  subparagraphs  (C)  and  (D)  of  paragraph  2  of
subsection (c) as amended, and paragraph 8 of subsection (b) and subpar-
agraphs (E) and (F) of paragraph 2 of subsection (c) as added by chapter
519 of the laws of 2013, are amended to read as follows:
  (b) A wellness program may include, but is not limited to, the follow-
ing programs or services:
  (1) the use of a health risk assessment tool;
  (2) a smoking cessation program;
  (3) a weight management program;
  (4) a stress AND/OR HYPERTENSION management program;
  (5) a worker injury prevention program;
  (6) a nutrition education program;
  (7) health or fitness incentive programs; [and]
  (8)  a coordinated weight management, nutrition, stress management and
physical fitness program to combat  the  high  incidence  of  adult  and
childhood obesity, asthma and other chronic respiratory conditions[.];
  (9) A SUBSTANCE OR ALCOHOL ABUSE CESSATION PROGRAM; AND
  (10) A PROGRAM TO MANAGE AND COPE WITH CHRONIC PAIN.
  (c)(1)  A  wellness program may use rewards and incentives for partic-
ipation provided  that  where  the  group  health  insurance  policy  or
subscriber  contract  is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or  a  rebate  or
refund  of  premium,  EXCEPT  AS  PROVIDED IN SECTION THREE THOUSAND TWO
HUNDRED THIRTY-ONE OF THIS ARTICLE, OR SECTION FOUR THOUSAND TWO HUNDRED
THIRTY-FIVE, FOUR THOUSAND THREE  HUNDRED  SEVENTEEN  OR  FOUR  THOUSAND
THREE  HUNDRED TWENTY-SIX OF THIS CHAPTER, OR SECTION FORTY-FOUR HUNDRED
FIVE OF THE PUBLIC HEALTH LAW.
  (2) Permissible rewards and incentives MAY include:
  (A) full or partial reimbursement of  the  cost  of  participating  in
smoking  cessation  [or], weight management, STRESS AND/OR HYPERTENSION,
WORKER INJURY PREVENTION,  NUTRITION  EDUCATION,  SUBSTANCE  OR  ALCOHOL
ABUSE CESSATION, OR CHRONIC PAIN MANAGEMENT AND COPING programs;
  (B)  full  or  partial  reimbursement  of  the cost of membership in a
health club or fitness center;
  (C) the waiver or reduction of copayments, coinsurance and deductibles
for preventive services covered under the  group  policy  or  subscriber
contract;
  (D)  monetary  rewards in the form of gift cards or gift certificates,
so long as the recipient of the reward is encouraged to use  the  reward
for  a  product  or a service that promotes good health, such as healthy
cook books, over the counter vitamins or exercise equipment;
  (E) full or partial reimbursement of the cost of  participating  in  a
stress management program or activity; and

S. 6696                            11

  (F)  full  or  partial reimbursement of the cost of participating in a
health or fitness program.
  (3)  Where  the  reward  involves a group member's meeting a specified
standard based on a health condition, the wellness program must meet the
requirements of 45 CFR Part 146.
  (4) A reward or incentive which involves a discounted premium rate  or
a  rebate or refund of premium shall be based on actuarial demonstration
that the wellness program can reasonably be expected to  result  in  the
overall  good  health and well being of the group AS PROVIDED IN SECTION
THREE THOUSAND TWO HUNDRED THIRTY-ONE OF  THIS  ARTICLE,  SECTIONS  FOUR
THOUSAND  TWO HUNDRED THIRTY-FIVE, FOUR THOUSAND THREE HUNDRED SEVENTEEN
AND FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS CHAPTER, AND  SECTION
FORTY-FOUR HUNDRED FIVE OF THE PUBLIC HEALTH LAW.
  S 3. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5)  EACH  INSURER  DOING BUSINESS IN THIS STATE, WHEN FILING WITH THE
SUPERINTENDENT ITS SCHEDULES OF PREMIUM RATES, RULES AND  CLASSIFICATION
OF  RISKS  FOR  USE  IN  CONNECTION WITH THE ISSUANCE OF ITS POLICIES OF
GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE FOR AN ACTUARIALLY APPROPRIATE REDUCTION  IN  PREMIUM  RATES  OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS  PROGRAM.  A  QUALIFIED  WELLNESS  PROGRAM CAN BE A RISK MANAGEMENT
SYSTEM THAT IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY  OTHER  SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL  FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-
MIZES ADVERSE HEALTH CONSEQUENCES DUE TO LIFESTYLE.    SUCH  A  WELLNESS
PROGRAM  MAY  HAVE  SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-
CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES HEALTHY LIVING ACTIVITIES OR DISCOURAGES  UNHEALTHY  LIVING  ACTIV-
ITIES.    SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS
PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED  THIRTY-NINE  OF  THIS
CHAPTER; AND
  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 4. Section 4317 of the insurance law is  amended  by  adding  a  new
subsection (c-1) to read as follows:
  (C-1)  SUBJECT  TO  THE  APPROVAL OF THE SUPERINTENDENT, AN INSURER OR
HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL  OR  GROUP  HEALTH
INSURANCE  CONTRACT PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARI-

S. 6696                            12

ALLY APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR
ENHANCEMENTS  APPROVED  BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S
OR INSURED'S ACTIVE PARTICIPATION IN A  QUALIFIED  WELLNESS  PROGRAM.  A
QUALIFIED  WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTI-
FIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM  OR  COURSE  OF
MEDICAL  CONDUCT  WHICH  HELPS  TO  PROMOTE PHYSICAL AND MENTAL FITNESS,
HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE  CONDITIONS  OF
ACUTE  OR  CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE
HEALTH CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY  HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE GENERAL GOOD HEALTH AND WELL-BEING OF THE  COVERED  POPULATION.  THE
INSURER  OR  HEALTH  MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC
OUTCOMES AS A RESULT OF AN ENROLLEE'S  OR  INSURED'S  ADHERENCE  TO  THE
APPROVED WELLNESS PROGRAM.
  S 5. Subsection (m) of section 4326 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
  (4)  APPROVAL  OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE
ORGANIZATION ISSUING A CONTRACT FOR QUALIFYING SMALL EMPLOYERS OR  INDI-
VIDUALS  PURSUANT  TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY APPRO-
PRIATE REDUCTION IN PREMIUM RATES  OR  OTHER  BENEFITS  OR  ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;

S. 6696                            13

  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 6. Section 4405 of the public health law is amended by adding a  new
subdivision 5-a to read as follows:
  5-A.  SUBJECT  TO  THE  APPROVAL  OF  THE  SUPERINTENDENT OF FINANCIAL
SERVICES, THE POSSIBLE PROVIDING OF AN ACTUARIALLY APPROPRIATE REDUCTION
IN PREMIUM RATES OR OTHER  BENEFITS  OR  ENHANCEMENTS  APPROVED  BY  THE
SUPERINTENDENT  OF  FINANCIAL SERVICES TO ENCOURAGE AN ENROLLEE'S ACTIVE
PARTICIPATION IN A QUALIFIED  WELLNESS  PROGRAM.  A  QUALIFIED  WELLNESS
PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPU-
LATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR  COURSE  OF  MEDICAL  CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL
OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-
CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES HEALTHY LIVING ACTIVITIES OR DISCOURAGES  UNHEALTHY  LIVING  ACTIV-
ITIES.  SUCH  ACTIVITIES  OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS
PROVIDED UNDER SECTION THREE THOUSAND TWO  HUNDRED  THIRTY-NINE  OF  THE
INSURANCE LAW; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 7. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided  that,  effective  immediately  any
rules  and regulations necessary to implement the provisions of this act
on its effective date are authorized and directed to be  added,  amended
and/or repealed on or before such date.
  S  2.  Severability clause. If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of

S. 6696                            14

competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the  legislature  that  this  act  would  have been enacted even if such
invalid provisions had not been included herein.
  S 3. This act shall take effect immediately  provided,  however,  that
the  applicable effective date of Parts A through G of this act shall be
as specifically set forth in the last section of such Parts.

Co-Sponsors

S6696A (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A9186A
Current Committee:
Assembly Health
Law Section:
Public Health Law
Laws Affected:
Amd §§2111, 2411, 2599-b, 2599-c, 2500, 2505, 2505-a, 2515, 2515-a & 2522, Pub Health L

S6696A (ACTIVE) - Bill Texts

view summary

Relates to combating the incidence of adult and childhood obesity and respiratory diseases; includes certain respiratory diseases and obesity in disease management demonstration programs; enacts provisions to reduce the incidence of certain respiratory diseases; expands the collection and reporting of data on obesity in the state; directs the health research science board to study obesity and respiratory diseases; expands ease of breast feeding in child day care centers and at work.

view sponsor memo
BILL NUMBER:S6696A

TITLE OF BILL: An act to amend the public health law, in relation to
including certain respiratory diseases and obesity within disease
management demonstration programs (Part A); to amend the public health
law, in relation to the reduction of emphysema, chronic bronchitis and
other chronic respiratory diseases in children (Part B); to amend the
public health law, in relation to directing the health research
science board to study respiratory diseases and obesity (Part C); and
to amend the public health law, in relation to breastfeeding of
infants and the adolescent pregnancy nutrition counseling program
(Part D)

PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to establish a comprehensive
inter-disciplinary program to combat childhood obesity. The incidence
of childhood obesity is a rapidly growing public health, social, and
economic concern that is adversely affecting the overall health and
wellbeing of our next generation of New Yorkers. In fact, acute and
chronic adverse health conditions such as diabetes, chronic coronary
conditions, and respiratory illnesses caused by obesity conditions is
about to overtake those acute and chronic adverse health conditions
caused by smoking tobacco. This bill attempts to better integrate
current programs and laws that relate to combating childhood obesity.

SUMMARY OF PROVISIONS:

This bill is an inter-disciplinary approach to address the high
incidence of childhood obesity in New York State.

PART A:

Section 1: Amends Public Health Law section 2111 to expand the scope
of disease management demonstration programs administered by DOH to
enhance the quality and cost-effectiveness of care rendered to
Medicaid-eligible persons who do not participate in Medicaid Managed
Care who have chronic health problems. Under current law,
demonstration programs can include chronic conditions related to
congestive heart failure, chronic obstructive pulmonary disease,
asthma and diabetes. This provision expands the scope of demonstration
programs to include emphysema, obesity, chronic bronchitis, and other
chronic respiratory diseases.

PART B:

Section 1: Amends Public Health Law section 2599-b to expand the scope
of programs administered by DOH to reduce the incidence and prevalence
of obesity in children and adolescents, especially among populations
with high rates of obesity. Under current law, the program looks to
address obesity related health complications such as diabetes, heart
disease, cancer, osteoarthritis, and asthma. This bill would expand
such programs to include obesity-related health complications such as
chronic bronchitis, and other chronic respiratory diseases.


In addition a new paragraph (h) is added to encourage DOH to
coordinate with the Education Department, Office of Temporary and
Disability Assistance, Office of Children and Family Services, and
other federal, state, and local agencies to incorporate strategies to
curtail the incidence of asthma, and chronic respiratory diseases to
enable adults and children to safely increase physical activity to
help curb the incidence of obesity.

Section 2: Amends Public Health Law section 2599-c that relates to the
Department's role in encouraging more school-based childhood obesity
prevention and physical activity programs. This bill adds that the
Department in advancing school-based childhood obesity prevention and
physical activity programs should cooperate with the Commissioners of
Agriculture & Markets and Education, and county boards of cooperative
extension.

PART C:

Section 1: Amends Public Health Law section 2411 which relates to the
powers and duties of the Commissioner. This provision authorizes the
Commissioner to act in an advisory and supervisory capacity with
regard to the Health Research Science Board as it relates to childhood
obesity, asthma, and chronic bronchitis or other respiratory diseases.
Further it expands the jurisdiction of such Board to research issues
related to childhood obesity, asthma, and other respiratory diseases
in addition to already being authorized to research breast, prostate
or testicular cancer.

Section 2: Amends Public Health Law section 2500 (1) which relates to
the Commissioner's duties as it relates to maternal and child health
to also include childhood obesity.

PART D:

Section 1: Amends Public Health Law section 2505-a to add child day
care facilities to the list of facilities that must post the
"statement of rights of breast feeding mothers". The goal of this
provision is to disseminate the statement of rights of breastfeeding
mothers to places where such mothers may frequent. Studies have shown
that encouraging the breast feeding of children reduces the risk that
such infants become obese later on in life.

Section 2: Amends Public Health Law section 2505, which relates to the
general powers of the Commissioner to regulate the collection, storage
and distribution of human breast milk. This provision authorizes the
Commissioner to conduct educational activities to encourage and
facilitate employers and child day care centers to establish
environments that do not discourage the practice of breast feeding.

Section 3: Amends Public Health Law section 2515 (2) that relates to
Adolescent Pregnancy Prevention and Services Program to add to
"services for eligible adolescents" vocational and education
counseling on pregnancy and child nutrition counseling for expectant
mothers to help curtail the incidence of childhood obesity.

Section 4: Amends Public Health Law section 2515-a(2) that relates to
the administration of community service project plans. The purpose of


these demonstration plans is to develop new methodologies to advance
the provision of health care that reduces adolescent pregnancy and
provide services to assist teenage mothers. These demonstration
programs tend to be located in geographical areas where there is a
high incidence of infant. mortality and low income families. This
provision expands the demonstration program areas to also include
geographical areas that have low birth weight babies or childhood
obesity.

Section 5: Amends Public Health Law section 2522 to empower the Health
Department to provide funds, if it deems appropriate, to finance
health and nutritional education and services to both parents
regarding childhood and adult obesity and asthma, and the prevention
or mitigation thereof.

JUSTIFICATION:

The growing prevalence of overweight and obese children is a crisis
that is facing the entire nation. Obesity related health care
expenditures in New York are some of the highest in the nation.
Further, contrary to the lower prevalence of obesity among adults,
children in New York are more likely to be obese or overweight when
compared to national trends. Obesity and overweight conditions in
individuals are leading to higher incidences of life threatening
conditions and substantial economic costs both to the State of New
York for health care costs and to employers in lost work time and
higher health care costs. Obesity in children tends to manifest itself
more widely among poorer children and children whose parents have
lower education levels.

The rising incidence of childhood obesity is a serious medical problem
that continues to grow, especially among poorer and minority
communities. Further, obesity is known to cause or exacerbate a number
of serious chronic medical disorders including hypertension,
dyslipidemia, cardiovascular disease, diabetes, and respiratory
dysfunction. Nearly 80% of patients with diabetes mellitus are obese,
while nearly 70% of diagnosed cases of cardiovascular disease are
related to obesity. Obesity ranks only second to smoking as a
preventable cause of death. Unfortunately, preventable deaths caused
by obesity conditions is rapidly approaching and will surpass those
deaths caused by smoking tobacco.

While the high prevalence of obesity and overweight conditions is an
important public health concern when it affects adults. It should be
of heightened concern that this adult affliction is now becoming more
common among children. When obesity conditions afflict children this
poses, significant quality of life detriments to such persons, reduces
the productivity of such individuals over a longer time of their life,
and hastens the onset of many chronic conditions that can hurt the
quality of life of such persons and their families.

The provisions of this bill are derived from a report by the
Independent Democratic Conference entitled "Childhood Obesity:
Mitigation and Prevention in the State of New York". This report
outlines the trends of the increasing incidence of childhood obesity,
some of the causes of this increase, and suggested courses of action
that can be taken to help reduce this ever increasing public health


problem. It is important for state agencies such as the Departments of
Health, Education, Agriculture & Markets, and Financial Services, the
Office of Children and Family Services coordinate their current
activities to curb this problem.

PRIOR LEGISLATIVE HISTORY:

This bill has some similar elements as S. 2374-A / A. 5322-A
(Klein/Crespo).

EFFECTIVE DATE:

Immediate.

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

                                 6696--A

                            I N  S E N A T E

                            February 28, 2014
                               ___________

Introduced  by  Sens.  KLEIN, CARLUCCI, SAVINO -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Health
  --  committee  discharged,  bill amended, ordered reprinted as amended
  and recommitted to said committee

AN ACT to amend the public health law, in relation to including  certain
  respiratory  diseases  and  obesity  within  disease management demon-
  stration programs (Part  A);  to  amend  the  public  health  law,  in
  relation  to  the reduction of emphysema, chronic bronchitis and other
  chronic respiratory diseases in children (Part B); to amend the public
  health law, in relation to directing the health research science board
  to study respiratory diseases and obesity (Part C); and to  amend  the
  public  health  law,  in  relation to breastfeeding of infants and the
  adolescent pregnancy nutrition counseling program (Part D)

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

  Section  1.   This act enacts into law major components of legislation
which combat the incidence of adult and child  obesity  and  respiratory
diseases.    Each component is wholly contained within a Part identified
as Parts A through D. The effective date for each  particular  provision
contained  within  such  Part  is  set forth in the last section of such
Part. Any provision in any section contained within  a  Part,  including
the effective date of the Part, which makes a reference to a section "of
this act", when used in connection with that particular component, shall
be  deemed to mean and refer to the corresponding section of the Part in
which it is found.  Section three of this act  sets  forth  the  general
effective date of this act.

                                 PART A

  Section  1.  Subdivisions 2 and 4 of section 2111 of the public health
law, as added by section 21 of part C of chapter 58 of the laws of 2004,
are amended to read as follows:
  2. The department shall establish the criteria  by  which  individuals
will  be  identified  as  eligible  for  enrollment in the demonstration

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14161-03-4

S. 6696--A                          2

programs.  Persons eligible for enrollment  in  the  disease  management
demonstration  program  shall  be  limited  to  individuals who: receive
medical assistance pursuant to title  eleven  of  article  five  of  the
social  services  law and may be eligible for benefits pursuant to title
18 of the social security act (Medicare); are not enrolled in a Medicaid
managed care plan, including individuals who are  not  required  or  not
eligible  to  participate  in Medicaid managed care programs pursuant to
section three hundred sixty-four-j of the social services law; are diag-
nosed with chronic health problems as may be  specified  by  the  entity
undertaking the demonstration program, including, but not limited to one
or  more of the following: congestive heart failure, chronic obstructive
pulmonary disease, asthma, EMPHYSEMA, CHRONIC BRONCHITIS, OTHER  CHRONIC
RESPIRATORY  DISEASES,  diabetes,  ADULT AND CHILDHOOD OBESITY, or other
chronic health conditions as may be specified by the department; or have
experienced or are likely to experience one or more hospitalizations  or
are  otherwise expected to incur excessive costs and high utilization of
health care services.
  4. The demonstration program shall offer evidence-based  services  and
interventions  designed to ensure that the enrollees receive high quali-
ty, preventative and cost-effective care, aimed at reducing the necessi-
ty for hospitalization or emergency room care or at reducing lengths  of
stay  when  hospitalization  is necessary. The demonstration program may
include screening of eligible enrollees,  developing  an  individualized
care  management  plan  for  each  enrollee  and implementing that plan.
Disease management demonstration programs that utilize information tech-
nology systems that allow for continuous application  of  evidence-based
guidelines to medical assistance claims data and other available data to
identify  specific  instances in which clinical interventions are justi-
fied and communicate indicated interventions to physicians, health  care
providers and/or patients, and monitor physician and health care provid-
er  response  to such interventions, shall have the enrollees, or groups
of enrollees, approved by the department for participation. The services
provided by the demonstration program as part  of  the  care  management
plan  may include, but are not limited to, case management, social work,
individualized health counselors, multi-behavioral goals  plans,  claims
data management, health and self-care education, drug therapy management
and  oversight, personal emergency response systems and other monitoring
technologies, SYSTEMATIC CHRONIC HEALTH CONDITIONS IDENTIFIED FOR  MONI-
TORING, telehealth services and similar services designed to improve the
quality and cost-effectiveness of health care services.
  S 2. This act shall take effect immediately.

                                 PART B

  Section  1.    Section  2599-b of the public health law, as amended by
section 88 of part B of chapter 58 of the laws of 2005,  is  amended  to
read as follows:
  S  2599-b.  Program development.   1. The program shall be designed to
prevent and reduce the incidence and prevalence of obesity  in  children
and adolescents, especially among populations with high rates of obesity
and  obesity-related health complications including, but not limited to,
diabetes, heart  disease,  cancer,  osteoarthritis,  asthma,  EMPHYSEMA,
CHRONIC  BRONCHITIS, OTHER CHRONIC RESPIRATORY DISEASES and other condi-
tions. The program shall use recommendations and  goals  of  the  United
States  departments  of  agriculture  and health and human services, the
surgeon general and centers for disease control AND PREVENTION in devel-

S. 6696--A                          3

oping and implementing guidelines for nutrition education  and  physical
activity projects as part of obesity prevention efforts. The content and
implementation  of  the  program shall stress the benefits of choosing a
balanced,  healthful  diet from the many options available to consumers,
without specifically targeting the elimination of  any  particular  food
group, food product or food-related industry.
  2.  The childhood obesity prevention program shall include, but not be
limited to:
  (a) developing media health promotion campaigns targeted  to  children
and adolescents and their parents and caregivers that emphasize increas-
ing consumption of low-calorie, high-nutrient foods, decreasing consump-
tion  of high-calorie, low-nutrient foods and increasing physical activ-
ity designed to prevent or reduce obesity;
  (b) establishing school-based childhood obesity  prevention  nutrition
education and physical activity programs including programs described in
section  twenty-five  hundred  ninety-nine-c of this article, as well as
other programs with linkages to physical and health  education  courses,
and  which  utilize  the  school health index of the National Center for
Chronic Disease Prevention and  Health  Promotion  or  other  recognized
school  health  assessment PURSUANT TO ARTICLE NINETEEN OF THE EDUCATION
LAW;
  (c) establishing community-based childhood obesity  prevention  nutri-
tion  education  and physical activity programs including programs which
involve parents and caregivers, and which encourage  communities,  fami-
lies,  child  care and other settings to provide safe and adequate space
and time for physical activity and encourage a healthy diet, AND CAN  BE
IN  COORDINATION  WITH COUNTY COOPERATIVE EXTENSION PROGRAMS ESTABLISHED
PURSUANT TO SECTION TWO HUNDRED TWENTY-FOUR-B OF THE COUNTY LAW;
  (d) coordinating with the state education  department,  department  of
agriculture  and markets, office of parks, recreation and historic pres-
ervation, office of temporary and disability assistance, office of chil-
dren and family services and other federal, state and local agencies  to
incorporate  strategies  to  prevent  and  reduce childhood obesity into
government food assistance, health, education and recreation programs;
  (e) sponsoring periodic conferences  or  meetings  to  bring  together
experts in nutrition, exercise, public health, mental health, education,
parenting,  media, food marketing, food security, agriculture, community
planning and other disciplines to examine  societal-based  solutions  to
the  problem  of  childhood obesity and issue guidelines and recommenda-
tions for New York state policy and programs;
  (f) developing training programs for medical and other health  profes-
sionals to teach practical skills in nutrition and exercise education to
children and their parents and caregivers; [and]
  (g)  developing  screening  programs  in coordination with health care
providers and institutions including but not limited to day care centers
and schools for overweight and obesity for  children  aged  two  through
eighteen  years,  using  body  mass  index (BMI) appropriate for age and
gender, and notification, in a manner protecting the confidentiality  of
such children and their families, of parents of BMI status, and explana-
tion  of  the consequences of such status, including recommended actions
parents may need to take and information about resources  and  referrals
available  to  families  to  enhance  nutrition and physical activity to
reduce and prevent obesity[.]; AND
  (H) COORDINATING WITH THE EDUCATION DEPARTMENT,  OFFICE  OF  TEMPORARY
AND  DISABILITY  ASSISTANCE,  OFFICE OF CHILDREN AND FAMILY SERVICES AND
OTHER FEDERAL, STATE AND LOCAL AGENCIES  TO  INCORPORATE  STRATEGIES  TO

S. 6696--A                          4

CURTAIL  THE  INCIDENCE  OF ASTHMA, CHRONIC BRONCHITIS AND OTHER CHRONIC
RESPIRATORY DISEASES TO ENABLE ADULTS AND CHILDREN  TO  SAFELY  INCREASE
PHYSICAL ACTIVITY.
  3. The department, IN COOPERATION WITH THE EDUCATION DEPARTMENT, shall
periodically  collect  and  analyze information from schools, health and
nutrition programs and other sources  to  determine  the  prevalence  of
childhood  obesity  in  New  York  state, and to evaluate, to the extent
possible, the effectiveness of the childhood obesity prevention program.
  S 2. The opening paragraph of section 2599-c of the public health law,
as amended by section 88 of part B of chapter 58 of the laws of 2005, is
amended to read as follows:
  The commissioner, IN COOPERATION WITH THE COMMISSIONERS  OF  EDUCATION
AND AGRICULTURE AND MARKETS, AND COUNTY BOARDS OF COOPERATIVE EXTENSION,
shall  encourage  the  establishment  of  school-based childhood obesity
prevention and physical activity programs that promote:
  S 3. This act shall take effect immediately.

                                 PART C

  Section 1.  Paragraphs (a), (b) and (c) of subdivision  1  of  section
2411  of  the  public  health  law, as amended by section 5 of part A of
chapter 60 of the laws of 2014, are amended to read as follows:
  (a) Survey state agencies, boards, programs and  other  state  govern-
mental  entities  to  assess  what, if any, relevant data has been or is
being collected which may be of use to  researchers  engaged  in  breast
cancer  research,  OR ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRON-
CHITIS OR OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
  (b) Consistent with the survey conducted pursuant to paragraph (a)  of
this  subdivision,  compile  a  list of data collected by state agencies
which may be of assistance  to  researchers  engaged  in  breast  cancer
research  as  established  in section twenty-four hundred twelve of this
title, AND ADULT AND CHILDHOOD OBESITY, ASTHMA,  CHRONIC  BRONCHITIS  OR
OTHER CHRONIC RESPIRATORY DISEASE RESEARCH;
  (c)  Consult  with the Centers for Disease Control and Prevention, the
National Institutes of Health, the Federal Agency For Health Care Policy
and Research, the National Academy of Sciences and  other  organizations
or  entities  which  may  be involved in cancer research to solicit both
information regarding breast cancer research projects that are currently
being conducted and recommendations for future  research  projects,  AND
ADULT AND CHILDHOOD OBESITY, ASTHMA, CHRONIC BRONCHITIS OR OTHER CHRONIC
RESPIRATORY DISEASE RESEARCH PROJECTS;
  S  2.  Subdivision  1  of  section  2500  of the public health law, as
amended by chapter 822 of the laws  of  1987,  is  amended  to  read  as
follows:
  1. The commissioner shall act in an advisory and supervisory capacity,
in  matters pertaining to the safeguarding of motherhood, the prevention
of maternal, perinatal, infant and child mortality,  the  prevention  of
diseases,  low birth weight, CHILDHOOD OBESITY, and defects of childhood
and the promotion of maternal, prenatal and child health, including care
in hospitals, and shall administer such services bearing on  the  health
of  mothers  and children for which funds are or shall hereafter be made
available.
  S 3. This act shall take effect immediately.

                                 PART D

S. 6696--A                          5

  Section 1.  Section 2505-a of the public health law, as added by chap-
ter 292 of the laws of 2009, is amended to read as follows:
  S  2505-a.  Rights of breastfeeding mothers. 1. The principles enunci-
ated in subdivision three of this section are declared to be the  public
policy  of  the  state  and  a copy of such statement of rights shall be
posted conspicuously in a public place  in  each  maternal  health  care
facility  AND  CHILD  DAY CARE FACILITY.   For purposes of this section,
"maternal health care provider" means a  physician,  midwife,  or  other
authorized practitioner attending a pregnant woman; and "maternal health
care  facility"  includes  hospitals  and  freestanding birthing centers
providing perinatal services in accordance with article twenty-eight  of
this chapter and applicable regulations.
  2. The commissioner shall make available to every maternal health care
provider [and], maternal health care facility AND CHILD DAY CARE FACILI-
TY,  on  the  health department's website for the purpose of health care
facilities to include such rights in the maternity  information  leaflet
as  described in section twenty-eight hundred three-j of this chapter, a
copy of the statement of rights provided in subdivision  three  of  this
section  in the top six languages other than English spoken in the state
according to the latest available data from the U.S. Bureau  of  Census,
and  shall adopt any rules and regulations necessary to ensure that such
patients are treated in accordance with the provisions  of  such  state-
ment.
  3. The statement of rights shall consist of the following:
                 "Breastfeeding Mothers' Bill of Rights"
  Choosing  the  way you will feed your new baby is one of the important
decisions you will make in preparing for your infant's arrival.  Doctors
agree  that  for most women breastfeeding is the safest and most healthy
choice. It is your right to be informed about the  benefits  of  breast-
feeding  and  have your health care provider [and], maternal health care
facility AND CHILD DAY CARE FACILITY encourage and  support  breastfeed-
ing.  You  have  the  right to make your own choice about breastfeeding.
Whether you choose to breastfeed or not you  have  the  following  basic
rights  regardless  of  your race, creed, national origin, sexual orien-
tation, gender identity or expression, or source  of  payment  for  your
health  care.  Maternal  health care facilities have a responsibility to
ensure that you understand these rights. They must provide this informa-
tion clearly for you and must provide an interpreter if necessary. These
rights may only be limited in cases where your health or the  health  of
your  baby requires it. If any of the following things are not medically
right for you or your baby, you should be fully informed  of  the  facts
and be consulted.
(1)  Before  You  Deliver,  if  you attend prenatal childbirth education
classes provided by the maternal health care facility and  all  hospital
clinics and diagnostic and treatment centers providing prenatal services
in  accordance with article 28 of the public health law you must receive
the breastfeeding mothers' bill of rights.  Each  maternal  health  care
facility  shall provide the maternity information leaflet, including the
Breastfeeding Mothers' Bill of Rights, in accordance with section  twen-
ty-eight hundred three-i of [this chapter] THE PUBLIC HEALTH LAW to each
patient  or  to  the  appointed  personal  representative at the time of
prebooking or time of admission to a maternal health care facility. Each
maternal health care provider shall give a  copy  of  the  Breastfeeding
Mothers'  Bill  of  Rights  to each patient at or prior to the medically
appropriate time.

S. 6696--A                          6

  You have the right to  complete  information  about  the  benefits  of
breastfeeding  for  yourself  and  your baby. This will help you make an
informed choice on how to feed your baby.
  You  have  the right to receive information that is free of commercial
interests and includes:
  *  How  breastfeeding  benefits  you  and  your  baby   nutritionally,
medically and emotionally;
  * How to prepare yourself for breastfeeding;
  * How to understand some of the problems you may face and how to solve
them.
(2) In The Maternal Health Care Facility:
  * You have the right to have your baby stay with you right after birth
whether you deliver vaginally or by cesarean section. You have the right
to begin breastfeeding within one hour after birth.
  *  You  have  the right to have someone trained to help you in breast-
feeding give you information and help you when you need it.
  * You have the right to have your baby not receive any bottle  feeding
or pacifiers.
  *  You  have the right to know about and refuse any drugs that may dry
up your milk.
  * You have the right to have your baby in your room with you 24  hours
a day.
  * You have the right to breastfeed your baby at any time day or night.
  *  You  have the right to know if your doctor or your baby's pediatri-
cian is advising against breastfeeding before any feeding decisions  are
made.
  *  You have the right to have a sign on your baby's crib clearly stat-
ing that your baby is breastfeeding and that no bottle  feeding  of  any
type is to be offered.
  *  You  have  the  right to receive full information about how you are
doing with breastfeeding and get help on how to improve.
  * You have the right to breastfeed your baby in the neonatal intensive
care unit. If nursing is not possible, every attempt  will  be  made  to
have your baby receive your pumped or expressed milk.
  * If you, or your baby, are re-hospitalized in a maternal care facili-
ty  after the initial delivery stay, the hospital will make every effort
to continue to support breastfeeding, to provide hospital grade electric
pumps and rooming in facilities.
  * You have the right to have help from someone  specially  trained  in
breastfeeding  support  and  expressing  breast  milk  if  your baby has
special needs.
  * You have the right to have a family member or friend receive breast-
feeding information from a staff member if you request it.
(3) When You Leave The Maternal Health Care Facility:
  * You have the right to  printed  breastfeeding  information  free  of
commercial material.
  * You have the right, unless specifically requested by you, and avail-
able  at  the  facility,  to  be  discharged  from  the facility without
discharge packs containing infant formula,  or  formula  coupons  unless
ordered by your baby's health care provider.
  *  You have the right to get information about breastfeeding resources
in your community including information on availability of breastfeeding
consultants, support groups and breast pumps.
  * You have the right to have the facility give you information to help
choose a medical provider for your baby and understand the importance of
a follow-up appointment.

S. 6696--A                          7

  * You have the right to receive information  about  safely  collecting
and storing your breast milk.
  *  You  have the right to breastfeed your baby in any location, public
or private, where you are otherwise authorized to be. Complaints can  be
directed to the New York State Division of Human Rights.
  * YOU HAVE A RIGHT TO BREASTFEED YOUR BABY AT YOUR PLACE OF EMPLOYMENT
OR  CHILD  DAY  CARE  CENTER  IN AN ENVIRONMENT THAT DOES NOT DISCOURAGE
BREASTFEEDING OR THE PROVISION OF BREAST MILK.
  All the above are your rights. If the maternal  health  care  facility
does not honor these rights you can seek help by contacting the New York
state  department  of  health  or  by  contacting the hospital complaint
hotline or via email.
  4. The commissioner shall make  regulations  reasonably  necessary  to
implement this section.
  S 2. Section 2505 of the public health law, as added by chapter 479 of
the laws of 1980, is amended to read as follows:
  S  2505.  Human  breast  milk;  collection,  storage and distribution;
general  powers  of  the  commissioner.    The  commissioner  is  hereby
empowered to:
  (a)  adopt  regulations  and  guidelines including, but not limited to
donor standards, methods of collection, and standards for  storage,  and
distribution of human breast milk;
  (b)  conduct  educational  activities  to inform the public and health
care providers of the availability of  human  breast  milk  for  infants
determined  to  require  such milk and to inform potential donors of the
opportunities for proper donation;
  (c) CONDUCT EDUCATIONAL ACTIVITIES TO ENCOURAGE AND FACILITATE EMPLOY-
ERS AND CHILD DAY CARE CENTERS TO ESTABLISH  ENVIRONMENTS  THAT  DO  NOT
DISCOURAGE BREASTFEEDING AND THE PROVISION OF BREAST MILK. SUCH ENVIRON-
MENTS MAY INCLUDE SANITARY LOCATIONS FOR BREASTFEEDING AND REFRIGERATORS
TO  ASSIST  IN  BREASTFEEDING  AND  FEEDING BABIES WITH EXPRESSED BREAST
MILK; AND
  (D) establish rules and regulations to effectuate  the  provisions  of
this section.
  S  3. Subdivision 2 of section 2515 of the public health law, as added
by section 20 of part A of chapter 58 of the laws of 2008, is amended to
read as follows:
  2. "Services for eligible adolescents" means those services, including
but not limited to: vocational and educational  counseling,  job  skills
training,  family life and parenting education, life skills development,
coordination, case management, primary preventive health care, PREGNANCY
AND CHILD NUTRITION COUNSELING FOR EXPECTANT MOTHERS TO CURB  THE  INCI-
DENCE  OF  CHILDHOOD  OBESITY,  family planning, social and recreational
programs, child care, outreach and advocacy, follow-up on service utili-
zation, crisis intervention, and efforts to stimulate community interest
and involvement.
  S 4. Paragraph (c) of subdivision 2 of section 2515-a  of  the  public
health  law,  as added by section 20 of part A of chapter 58 of the laws
of 2008, is amended to read as follows:
  (c) serve a geographic area where the incidence of  infant  mortality,
LOW  BIRTH  WEIGHT INFANTS, CHILDHOOD OBESITY and the prevalence of low-
income families are high and where the availability or accessibility  of
services for eligible adolescents is low;
  S  5.  Subdivision  (b)  of  section 2522 of the public health law, as
amended by chapter 484 of the laws of 2009, is amended and a new  subdi-
vision (e-1) is added to read as follows:

S. 6696--A                          8

  (b) promotion of community awareness of the benefits TO THE MOTHER AND
CHILD of preconception health and early and continuous prenatal care;
  (E-1)  HEALTH AND NUTRITIONAL EDUCATION AND SERVICES FOR BOTH PARENTS,
REGARDING CHILDHOOD AND ADULT OBESITY AND ASTHMA, AND THE PREVENTION  OR
MITIGATION THEREOF;
  S 6. This act shall take effect immediately.
  S  2. Severability clause.  If any clause, sentence, paragraph, subdi-
vision, section or part of this act shall be adjudged by  any  court  of
competent  jurisdiction  to  be invalid, such judgment shall not affect,
impair, or invalidate the remainder thereof, but shall  be  confined  in
its  operation  to the clause, sentence, paragraph, subdivision, section
or part thereof directly involved in the controversy in which such judg-
ment shall have been rendered. It is hereby declared to be the intent of
the legislature that this act would  have  been  enacted  even  if  such
invalid provisions had not been included herein.
  S  3.  This  act shall take effect immediately provided, however, that
the applicable effective date of Parts A through D of this act shall  be
as specifically set forth in the last section of such Parts.

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