NY State Senate Bill 2017-S6795

Senate Bill S6795

2017-2018 Legislative Session

Relates to expanding the function of the New York state medical indemnity fund such that it will serve as a funding source for future health care costs

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Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to health
Jun 18, 2017	referred to rules

2017-S6795 (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§2999-g - 2999-j, Pub Health L

2017-S6795 (ACTIVE) - Summary

Relates to expanding the function of the New York state medical indemnity fund such that it will serve as a funding source for future health care costs associated with neurological injuries resulting from medical services provided or not provided.

2017-S6795 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S6795

 TITLE OF BILL :

An act to amend the public health law, in relation to expanding the
function of the New York state medical indemnity fund such that it
will serve as a funding source for future health care costs associated
with neurological injuries resulting from medical services provided or
not provided

 PURPOSE :

To further the State's interest in reducing premium costs for medical
malpractice insurance coverage, the mission of the Medical Indemnity
Fund is expanded to provide a funding source for future health care
costs associated with all neurological injuries resulting from medical
services provided or not provided and not just those that are birth
related.

 SUMMARY OF PROVISIONS :

Section 1 adds the purpose of the expansion to the purposes of the
law.

Section 2 replaces the definition of "birth related neurological
injury" with a new definition of "neurological injury".

Sections 3 and 4 makes largely technical corrections to the law that
insure that annual funding amounts are based on actuarial calculations
of the estimated liabilities of the fund for the succeeding year and
to conform the law with current practice by requiring the court to
determine if there has been a prima facie showing that the plaintiff
or claimant is a qualified plaintiff.

Section 5 establishes an effective date and makes other changes.

 JUSTIFICATION :

New York continue to have the highest medical malpractice costs of any
state in the country. According to data compiled by Diederich
Healthcare, and reported in the Washington Post on March 15, 2014,
medical malpractice lawsuits paid out more in New York in 2013 than in
any other state "by a huge margin." The data shows that lawsuits in
New York paid out $690 million, vastly more than the second highest
state, Pennsylvania, which paid out $357 million.

Recognizing this, the Executive and Legislature agreed in the State
fiscal year 2011-12 budget legislation to create the New York State
Medical Indemnity Fund. The Fund pays for future health care costs for
individuals who suffered from a birth related neurological injury. The
Fund relieves hospitals and physicians from purchasing medical
coverage that includes coverage of future health care costs for such
individuals.

As originally proposed, the Fund would have covered future health care
costs for all individuals suffering neurological injuries, not just
birth-related injuries. This bill reflects the original proposal by
replacing "birth related neurological injury" with "neurological
injury".

 LEGISLATIVE HISTORY :

New bill.

 FISCAL IMPLICATIONS :

Savings to be determined.

 EFFECTIVE DATE :
Immediately and shall be deemed to have been in full force and effect
on and after July 1, 2017.

2017-S6795 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6795
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                               June 18, 2017
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the public health law,  in  relation  to  expanding  the
   function  of  the  New  York state medical indemnity fund such that it
   will serve as a funding source for future health care costs associated
   with neurological injuries resulting from medical services provided or
   not provided
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  2999-g  of  the  public  health law, as added by
 section 52 of part H of chapter 59 of the laws of 2011,  is  amended  to
 read as follows:
   §  2999-g.  Purpose  of  this title. Creation AND EXPANSION of the New
 York state medical indemnity fund.  [There is hereby created the] 1. THE
 New York state medical indemnity fund (the "fund")[. The purpose of  the
 fund  is] WAS CREATED to provide a funding source for future health care
 costs associated with birth related neurological injuries, in  order  to
 reduce premium costs for medical malpractice insurance coverage.
   2.  TO  FURTHER  THE  STATE'S  INTEREST  IN REDUCING PREMIUM COSTS FOR
 MEDICAL MALPRACTICE INSURANCE COVERAGE, THE FUND'S MISSION  IS  EXPANDED
 SUCH  THAT THE FUND WILL PROVIDE A FUNDING SOURCE FOR FUTURE HEALTH CARE
 COSTS ASSOCIATED WITH ALL NEUROLOGICAL INJURIES RESULTING  FROM  MEDICAL
 SERVICES  PROVIDED  OR  NOT  PROVIDED  AND NOT JUST THOSE THAT ARE BIRTH
 RELATED.
   § 2. Section 2999-h of the public health law, as added by  section  52
 of part H of chapter 59 of the laws of 2011, subdivision 1 as amended by
 chapter  517 of the laws of 2016 and subdivision 3 as amended by chapter
 4 of the laws of 2017, is amended to read as follows:
   § 2999-h. Definitions. As used in this title, unless  the  context  or
 subject matter requires otherwise:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13269-01-7

 S. 6795                             2
 
   1.  ["Birth-related  neurological injury" means an injury to the brain
 or spinal cord of a live infant caused by the deprivation of  oxygen  or
 mechanical injury occurring in the course of labor, delivery or resusci-
 tation,  or  by  other  medical services provided or not provided during
 delivery  admission,  that  rendered  the  infant  with  a permanent and
 substantial motor impairment or with a developmental disability as  that
 term is defined by section 1.03 of the mental hygiene law, or both. This
 definition shall apply to live births only.
   2.] "Fund" means the New York state medical indemnity fund.
   2.  "NEUROLOGICAL  INJURY" MEANS AN INJURY TO THE BRAIN OR SPINAL CORD
 OF A PERSON CAUSED BY MEDICAL SERVICES PROVIDED  OR  NOT  PROVIDED  THAT
 RENDERED THE PERSON WITH A:
   (A) PERMANENT AND SUBSTANTIAL MOTOR IMPAIRMENT, AND/OR
   (B) DISABILITY THAT (I) IS ATTRIBUTABLE TO (A) DEVELOPMENTAL DISABILI-
 TIES, CEREBRAL PALSY, EPILEPSY, NEUROLOGICAL IMPAIRMENT, FAMILIAL DYSAU-
 TONOMIA  OR  AUTISM;  (B)  ANY  OTHER  CONDITION OF A PERSON FOUND TO BE
 CLOSELY RELATED TO DEVELOPMENTAL  DISABILITIES  BECAUSE  SUCH  CONDITION
 RESULTS  IN  SIMILAR  IMPAIRMENT  OF GENERAL INTELLECTUAL FUNCTIONING OR
 ADAPTIVE  BEHAVIOR  TO  THAT  OF  DEVELOPMENTALLY  DISABLED  PERSONS  OR
 REQUIRES  TREATMENT  AND  SERVICES  SIMILAR  TO  THOSE REQUIRED FOR SUCH
 PERSON; OR (C) DYSLEXIA RESULTING FROM A DISABILITY DESCRIBED IN SUBPAR-
 AGRAPH (A) OR (B) OF THIS  PARAGRAPH;  (II)  HAS  CONTINUED  OR  CAN  BE
 EXPECTED  TO  CONTINUE INDEFINITELY; AND (III) CONSTITUTES A SUBSTANTIAL
 HANDICAP TO SUCH PERSON'S ABILITY TO FUNCTION NORMALLY IN SOCIETY.
   3. "Qualifying health care costs" means the future medical,  hospital,
 surgical, nursing, dental, rehabilitation, habilitation, respite, custo-
 dial, durable medical equipment, home modifications, assistive technolo-
 gy,  vehicle  modifications,  transportation for purposes of health care
 related appointments, prescription and non-prescription medications, and
 other health care costs actually incurred for services rendered  to  and
 supplies  utilized  by qualified plaintiffs, which are necessary to meet
 their health care needs, as determined  by  their  treating  physicians,
 physician assistants, or nurse practitioners and as otherwise defined by
 the commissioner in regulation.
   4. "Qualified plaintiff" means every plaintiff or claimant who (i) has
 been found by a jury or court to have sustained a [birth-related] neuro-
 logical  injury  as  the  result  of  medical  malpractice,  or (ii) has
 sustained a [birth-related] neurological injury as the result of alleged
 medical malpractice, and has settled his or her lawsuit or claim  there-
 for.
   5.  Any  reference  to  the "department of financial services" and the
 "superintendent of financial services" in this title shall  mean,  prior
 to  October third, two thousand eleven, respectively, the "department of
 insurance" and "superintendent of insurance."
   § 3. Section 2999-i of the public health law, as added by  section  52
 of part H of chapter 59 of the laws of 2011, subdivision 1 as amended by
 section  29  of  part D of chapter 56 of the laws of 2012, is amended to
 read as follows:
   § 2999-i. Custody and administration of the fund.  1. (a) The  commis-
 sioner  of  taxation  and finance shall be the custodian of the fund and
 the special account established pursuant to section ninety-nine-t of the
 state finance law. All payments from the  fund  shall  be  made  by  the
 commissioner  of  taxation  and  finance upon certificates signed by the
 superintendent of financial services, or his or her designee, as herein-
 after provided. The fund shall be separate and apart from any other fund
 and from all other state monies; provided, however, that monies  of  the

 S. 6795                             3
 
 fund  may be invested as set forth in paragraph (b) of this subdivision.
 No monies from the fund shall be transferred  to  any  other  fund,  nor
 shall  any  such  monies be applied to the making of any payment for any
 purpose other than the purpose set forth in this title.
   (b)  Any monies of the fund not required for immediate use may, at the
 discretion of the [commissioner] SUPERINTENDENT of financial services in
 consultation with the commissioner of health and  the  director  of  the
 budget, be invested by the commissioner of taxation and finance in obli-
 gations  of  the United States or the state or obligations the principal
 and interest of which are guaranteed by the United States or the  state.
 The  proceeds  of  any  such investment shall be retained by the fund as
 assets to be used for the purposes of the fund.
   2. (a) The fund shall be administered by the superintendent of  finan-
 cial  services  or his or her designee in accordance with the provisions
 of this article.
   (b) The superintendent of financial services  shall  have  all  powers
 necessary and proper to carry out the purposes of the fund.
   (c)  Notwithstanding  any contrary provision of this section, sections
 one hundred twelve and one hundred sixty-three of the state finance  law
 or  any other contrary provision of law, the superintendent of financial
 services is authorized to enter into a contract or contracts  without  a
 competitive bid or request for proposal process for purposes of adminis-
 tering  the  fund for the first year of its operation and in preparation
 therefor.
   (d) The department of financial services and the department OF  HEALTH
 shall post on their websites information about the fund, eligibility for
 enrollment in the fund, and the process for enrollment in the fund.
   3.  The  expense  of  administering  the  fund, including the expenses
 incurred by the department OF FINANCIAL SERVICES AND/OR  THE  DEPARTMENT
 OF HEALTH, shall be paid from the fund.
   4. Monies for the fund will be provided pursuant to this chapter.
   5.  For  the  state  fiscal  year  beginning April first, two thousand
 [eleven] EIGHTEEN and ending March thirty-first, two  thousand  [twelve,
 the  state  fiscal  year  beginning April first, two thousand twelve and
 ending March thirty-first, two thousand thirteen, and the  state  fiscal
 year beginning April first, two thousand thirteen and ending March thir-
 ty-first,  two thousand fourteen] NINETEEN, AND ANNUALLY THEREAFTER, the
 superintendent of financial services shall cause to  be  deposited  into
 the  fund  for  each  such  fiscal year the amount appropriated for such
 purpose. [Beginning April first,  two  thousand  fourteen  and  annually
 thereafter,  the  superintendent of financial services shall cause to be
 deposited into the fund, subject to available appropriations, an  amount
 equal  to  the difference between the amount appropriated to the fund in
 the preceding fiscal year, as increased by the adjustment factor defined
 in subdivision seven of this section, and the assets of the fund at  the
 conclusion  of  that fiscal year.] THE TOTAL AMOUNT TO BE DEPOSITED INTO
 THE FUND SHALL BE BASED UPON AN ACTUARIAL CALCULATION,  CONDUCTED  QUAR-
 TERLY  BY  THE  SUPERINTENDENT  OF  FINANCIAL SERVICES, OF THE ESTIMATED
 LIABILITIES OF THE FUND FOR THE NEXT SUCCEEDING YEAR.
   6. (a) Following the deposit referenced in subdivision  five  of  this
 section, the superintendent of financial services shall conduct an actu-
 arial  calculation  of  the  estimated  liabilities  of the fund for the
 coming year resulting from the  qualified  plaintiffs  enrolled  in  the
 fund.  The FUND administrator shall from time to time adjust such calcu-
 lation.  If the total of all estimates of current liabilities equals  or
 exceeds  eighty  percent  of  the fund's assets, then the fund shall not

 S. 6795                             4
 
 accept any new enrollments until a new deposit has been made pursuant to
 subdivision five of this section. When, as a result of such new deposit,
 the fund's liabilities no longer exceed eighty  percent  of  the  fund's
 assets,  the fund administrator shall enroll new qualified plaintiffs in
 the order that an application  for  enrollment  has  been  submitted  in
 accordance  with  subdivision seven of section twenty-nine hundred nine-
 ty-nine-j of this title.
   (b) Whenever enrollment is suspended pursuant to paragraph (a) of this
 subdivision and until such time as enrollment resumes pursuant  to  such
 paragraph: (i) notice of such suspension shall be promptly posted on the
 [department's] website OF THE DEPARTMENT OF HEALTH and on the website of
 the  department of financial services; (ii) the fund administrator shall
 deny each application for enrollment that  had  been  received  but  not
 accepted  prior  to  the  date  of  suspension  and each application for
 enrollment received ON AND after the date of such suspension; and  (iii)
 notification  of  each  such  denial  shall  be made to the plaintiff or
 claimant or persons authorized to act on behalf  of  such  plaintiff  or
 claimant  and all defendants in regard to such plaintiff or claimant, to
 the extent they are known  to  the  fund  administrator.  Judgments  and
 settlements for plaintiffs or claimants for whom applications are denied
 under  this  paragraph  or  who  are  not eligible for enrollment due to
 suspension pursuant to paragraph (a) of this subdivision shall be satis-
 fied as if this title had not been enacted.
   (c) Following a suspension, whenever enrollment  resumes  pursuant  to
 paragraph  (a)  of  this subdivision, notice that enrollment has resumed
 shall be promptly posted on the [department's] website OF THE DEPARTMENT
 OF HEALTH and on the website of the department of financial services.
   (d) The suspension of enrollment pursuant to  paragraph  (a)  of  this
 subdivision  shall  not  impact payment under the fund for any qualified
 plaintiffs already enrolled in the fund.
   [7. For purposes of this section, the adjustment factor referenced  in
 this  section shall be the ten year rolling average medical component of
 the consumer price index as published by the United States department of
 labor, bureau of labor statistics, for the preceding ten years.]
   § 4. Section 2999-j of the public health law, as added by  section  52
 of  part  H  of  chapter 59 of the laws of 2011, subdivisions 2 and 4 as
 amended by chapter 517 of the laws of 2016, and paragraph (c) of  subdi-
 vision  2 as amended by chapter 4 of laws of 2017, is amended to read as
 follows:
   § 2999-j. Payments from the fund. 1. The fund shall be used to pay the
 qualifying health care costs of qualified plaintiffs.
   2. The provision of qualifying health care costs to  qualified  plain-
 tiffs  shall  not be subject to prior authorization, except as described
 by the commissioner in regulation; provided, however:
   (a) such  regulation  shall  not  prevent  qualified  plaintiffs  from
 receiving  care  or  assistance  that would, at a minimum, be authorized
 under the medicaid program;
   (b) if any prior authorization is required  by  such  regulation,  the
 regulation  shall require that requests for prior authorization be proc-
 essed within a reasonably prompt period of time  and[,  subject  to  the
 provisions of subdivision two-a of this section,] shall identify a proc-
 ess  for  prompt  administrative  review  of any denial of a request for
 prior authorization; and
   (c) such regulations shall not prohibit qualifying health  care  costs
 on  the  grounds  that  the qualifying health care cost may incidentally

 S. 6795                             5
 
 benefit other members of the household, provided that whether the quali-
 fying health care cost primarily benefits the patient may be considered.
   3.  In  determining  the  amount of qualifying health care costs to be
 paid from the fund, any such cost or expense  that  was  or  will,  with
 reasonable  certainty, be paid, replaced or indemnified from any collat-
 eral source as provided by subdivision (a) of section forty-five hundred
 forty-five of the civil practice law and rules shall  not  constitute  a
 qualifying  health  care  cost  and shall not be paid from the fund. For
 purposes of this title, "collateral source" shall not include [medicare]
 MEDICARE or Medicaid.
   4. The amount of qualifying health care costs to be paid from the fund
 shall be calculated on the basis of one hundred percent of the usual and
 customary cost. For the purposes of this section, "usual  and  customary
 costs"  shall  mean  the  eightieth  percentile  of  all charges for the
 particular health care service performed by a provider in  the  same  or
 similar specialty and provided in the same geographical area as reported
 in a benchmarking database maintained by a nonprofit organization speci-
 fied  by  the superintendent of financial services. If no such rates are
 available qualifying health care costs shall be calculated on the  basis
 of no less than one hundred thirty percent of Medicaid or Medicare rates
 of  reimbursement,  whichever  is  higher. If no such rate exists, costs
 shall be reimbursed as defined by the commissioner in regulation.
   5. Claims for the payment or reimbursement from the fund of qualifying
 health care costs shall be made upon forms prescribed and  furnished  by
 the  fund  administrator  in  consultation  with the commissioner and in
 conjunction with regulations establishing a mechanism for submission  of
 claims by health care providers directly to the fund, where practicable.
   6.  (a)  Every  settlement  agreement  for  claims  arising  out  of a
 plaintiff's or claimant's [birth related] neurological injury subject to
 this title, and  that  provides  for  the  payment  of  future  [medical
 expenses]  HEALTH  CARE  COSTS  for  the plaintiff or claimant, SHALL BE
 SUBMITTED FOR COURT REVIEW AND APPROVAL AND shall provide that,  in  the
 event  the  [administrator  of the fund determines that the plaintiff or
 claimant is a qualified plaintiff] COURT FINDS THAT  THERE  HAS  BEEN  A
 PRIMA FACIE SHOWING THAT THE PLAINTIFF OR CLAIMANT IS A QUALIFIED PLAIN-
 TIFF, all payments for future [medical expenses] HEALTH CARE COSTS shall
 be  paid  in  accordance with this title, in lieu of that portion of the
 settlement agreement that provides for payment of such [expenses] FUTURE
 HEALTH CARE COSTS. The plaintiff's or claimant's future medical expenses
 shall be paid in accordance with this  title.  When  such  a  settlement
 agreement  does  not so provide, the court shall direct the modification
 of the agreement to include such term as a condition of court approval.
   (b) In any case where the jury or court has made an award  for  future
 [medical  expenses]  HEALTH  CARE COSTS arising out of a [birth related]
 neurological injury, [any party to such action or person  authorized  to
 act  on  behalf  of  such  party may make application to the court that]
 SUBJECT TO THIS TITLE, THE COURT SHALL DETERMINE IF  THERE  HAS  BEEN  A
 PRIMA FACIE SHOWING THAT THE PLAINTIFF OR CLAIMANT IS A QUALIFIED PLAIN-
 TIFF,  AND,  IF THE COURT SHALL SO DETERMINE, the judgment SHALL reflect
 that, in lieu of that portion of the award that provides for payment  of
 such  [expenses, and upon a determination by the fund administrator that
 the plaintiff is a qualified plaintiff] FUTURE HEALTH  CARE  COSTS,  the
 future [medical expenses] HEALTH CARE COSTS of the plaintiff OR CLAIMANT
 shall  be  paid  out of the fund in accordance with this title.  [Upon a
 finding by the court that the applicant has made a prima  facie  showing

 S. 6795                             6

 that the plaintiff is a qualified plaintiff, the court shall ensure that
 the judgment so provides.]
   7.  A  qualified plaintiff shall be enrolled when [(a)] such plaintiff
 or person authorized to act on behalf of such person, upon notice to all
 defendants, or any of the defendants in regard to the plaintiff's claim,
 upon notice to such plaintiff, makes an application  for  enrollment  by
 providing  the  fund administrator with a certified copy of the judgment
 or of the court approved settlement agreement; [and (b) the fund  admin-
 istrator determines upon the basis of such judgment or settlement agree-
 ment and any additional information the fund administrator shall request
 that  the  relevant  provisions  of subdivision six of this section have
 been met and that the plaintiff is a qualified plaintiff;] provided that
 no enrollment shall occur when the fund is closed to enrollment pursuant
 to subdivision six of section twenty-nine hundred ninety-nine-i of  this
 title.
   8. As to all claims, the fund administrator shall:
   (a)  determine which of such costs are qualifying health care costs to
 be paid from the fund; and
   (b) thereupon certify to the  commissioner  of  taxation  and  finance
 those costs that have been determined to be qualifying health care costs
 to be paid from the fund.
   9.  Payments  from the fund shall be made by the commissioner of taxa-
 tion and finance on the said certificate of the superintendent of finan-
 cial services. No payment shall be made by the commissioner of  taxation
 and  finance in excess of the amount certified. Promptly upon receipt of
 the said certificate of the superintendent of  financial  services,  the
 commissioner of taxation and finance shall pay the qualified plaintiff's
 health  care provider or reimburse the qualified plaintiff the amount so
 certified for payment.
   10. Payment from the fund shall not give the fund any right of  recov-
 ery against any qualified plaintiff or such qualified plaintiff's attor-
 ney except in the case of fraud or mistake.
   11.  All health care providers shall accept from qualified plaintiff's
 or persons authorized to act on behalf of such  plaintiff's  assignments
 of  the  right  to  receive payments from the fund for qualifying health
 care costs.
   12. Health insurers (other  than  [medicare]  MEDICARE  and  Medicaid)
 shall be the primary payers of qualifying health care costs of qualified
 plaintiffs.    Such costs shall be paid from the fund only to the extent
 that health insurers or other collateral sources or  other  persons  are
 not  otherwise obligated to make payments therefor. Health insurers that
 make payments for qualifying health care costs to or on behalf of quali-
 fied plaintiffs shall have no right of recovery against and  shall  have
 no lien upon the fund or any person or entity nor shall the fund consti-
 tute  an  additional  payment  source  to  offset the payments otherwise
 contractually required to be made by such health  insurers.  The  super-
 intendent  of financial services shall have the authority to enforce the
 provisions of this subdivision.
   13. Except as provided for by this title, with respect to a  qualified
 plaintiff,  no  payment shall be required to be made by any defendant or
 such defendant's insurer for qualifying health care costs and  no  judg-
 ment shall be made or entered requiring that any such payment be made by
 any defendant or such defendant's insurer for such health care costs.
   14.  The  determination  of  the  qualified plaintiff's attorney's fee
 shall be based upon the entire sum awarded by the jury or the  court  or
 the  full  sum  of  the  settlement,  as  the case may be. The qualified

 S. 6795                             7
 
 plaintiff's attorney's fee shall be paid in a lump sum by the defendants
 and their insurers pursuant to section four  hundred  seventy-four-a  of
 the  judiciary  law; provided however that the portion of the [attorney]
 ATTORNEY'S  fee  that  is  allocated to the non-fund elements of damages
 shall be deducted from the non-fund portion of the award  in  a  propor-
 tional manner.
   15.  The  commissioner,  in  consultation  with  the superintendent of
 financial services, shall promulgate, amend and enforce  all  rules  and
 regulations  necessary  for  the  proper  administration  of the fund in
 accordance with the provisions  of  this  section,  including,  but  not
 limited  to,  those  concerning the payment of claims and concerning the
 actuarial calculations  necessary  to  determine,  annually,  the  total
 amount  to  be  paid  into the fund as provided herein, and as otherwise
 needed to implement this title.
   16. The commissioner shall convene a consumer advisory  committee  for
 the purpose of REVIEWING THE RULES AND REGULATIONS PROMULGATED BY SUBDI-
 VISION  FIFTEEN  OF THIS SECTION AND providing information, as requested
 by the commissioner, in the development of [the  regulations  authorized
 by  subdivision fifteen of this section] ANY REVISIONS TO SUCH RULES AND
 REGULATIONS AND/OR ANY ADDITIONAL  RULES  AND  REGULATIONS  REQUIRED  TO
 IMPLEMENT THIS TITLE.
   §  5.  This  act  shall take effect immediately and shall be deemed to
 have been in full force and effect on and after July 1, 2017,  provided,
 however, that:
   (a)  if  section  5  of chapter 517 of the laws of 2016 shall not have
 taken effect on or before such  date,  then  subdivision  4  of  section
 2999-j of the public health law, as amended by section four of this act,
 shall  take effect on the same date and in the same manner as such chap-
 ter of the laws of 2016 takes effect; provided, further, that the amend-
 ments to subdivision 4 of section 2999-j of the public health  law  made
 by  section  four  of  this  act shall not affect the expiration of such
 subdivision and shall be deemed to expire therewith;
   (b) with respect to  lawsuits  involving  birth  related  neurological
 injury  subject  to  this  title (i.e., an injury to the brain or spinal
 cord of a live infant caused by the deprivation of oxygen or  mechanical
 injury occurring in the course of labor, delivery or resuscitation or by
 other  medical  services provided or not provided during delivery admis-
 sion that rendered the infant with a  permanent  and  substantial  motor
 impairment or with a developmental disability as that term is defined by
 section 1.03 of the mental hygiene law, or both), the provisions of this
 act  shall apply if no judgment has been entered or no settlement agree-
 ment has been entered into by the parties before  April  1,  2011,  and,
 with respect to all other lawsuits involving neurological injury subject
 to this title, the provisions of this act shall apply if no judgment has
 been  entered  or  no  settlement  has  been entered into by the parties
 before the effective date of this act;
   (c) this act shall not be construed to alter, change,  affect,  impair
 or defeat any rights, obligations, duties or interests accrued, incurred
 or conferred prior to the effective date of this act; and
   (d)  the provisions of this act shall become effective notwithstanding
 the failure of the commissioner  of  health  or  the  superintendent  of
 financial services to adopt or amend or promulgate rules and regulations
 implementing this act.

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