NY State Senate Bill 2019-S5296

Senate Bill S5296

2019-2020 Legislative Session

Authorizes physicians and pharmacists to enter into comprehensive medication management protocols for their patients

download bill text pdf

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 08, 2020	referred to health
Apr 23, 2019	referred to health

2019-S5296 (ACTIVE) - Details

See Assembly Version of this Bill:: A3849
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add Art 29-H §2999-ee, Pub Health L; add §6801-b, Ed L; amd §5, Chap 21 of 2011
Versions Introduced in Other Legislative Sessions:: 2017-2018: S7682, A8664
2021-2022: S6110, A6699
2023-2024: S3591

2019-S5296 (ACTIVE) - Summary

Authorizes physicians and pharmacists to enter into comprehensive medication management protocols for their patients.

2019-S5296 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S5296

SPONSOR: BRESLIN
 
TITLE OF BILL:  An act to amend the public health law and the educa-
tion law, in relation to comprehensive medication management; and to
amend chapter 21 of the laws of 2011 amending the education law relating
to authorizing pharmacists to perform collaborative drug therapy manage-
ment with physicians in certain settings, in relation to making the
provisions of such chapter permanent

 
PURPOSE OR GENERAL IDEA OF BILL:

Authorizes physicians to refer selected patients to qualified pharma-
cists for comprehensive medication management services specified in a
written protocol issued by the treating physician

 
SUMMARY OF PROVISIONS:

Section 1 adds Article 29-H to Public Health Law entitled Comprehensive
Medication Management, includes definitions and authorizes a treating
physician to refer one or more patients to a qualified pharmacist for

comprehensive medication management services specified in the written
protocol. Section 1 defines patients eligible for referral by their
treating physician as those with a chronic disease or diseases, who have
not met the clinical goals of therapy, are at risk for hospitalization,
or who are otherwise in need of extra medication-related services as
determined by their physician. Section 1 of the bill lists medication-
related services.  The written protocol applies to an individual named
pharmacist and a named physician and is voluntary for all parties
including the patient. This section requires sharing of patient data in
real-time through a bi-directional interoperable medical records system.

Section 2 amends Section 6801 of the Education Law to create a new para-
graph Section 6801-b. This section recognizes comprehensive medication
management as a service that can be provided by a qualified pharmacist
pursuant to a protocol with a licensed physician, and conforms to chang-
es being made in Public Health Law.

Section 3 amend s Section 5 of chapter 21 of the laws of 2011, amending
the education law relating to authorizing pharmacists to perform colla-
borative drug therapy management with physicians in hospital facilities
to remove the sunset and make the law permanent.

Section 4 establishes the effective date.

 
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):

Deletion of Section 1 (c) language: but not limited to electronic bidi-
rectional. Insert language Section 1(c): as specified in a comprehensive
medication management protocol

 
JUSTIFICATION:

Comprehensive Medication Management (CMM) has been accepted by the
Health Department as a policy recommendation from a Value-Based Payment
stakeholder workgroup. CMM is a professional service provided by quali-
fied pharmacists to patients who are referred by their treating physi-
cians for extra medication support services. -The service represents a
targeted strategy developed to reduce avoidable hospitalizations and
healthcare costs resulting from the exacerbation of chronic diseases due
to sub-optimal medication use. With expertise in pharmacotherapy and
pharmacokinetics, pharmacists are uniquely positioned healthcare provid-
ers to address medication-related problems. One key aspect of profes-
sional practice is patient counseling which includes an assessment of a
patient's understanding of how to use the medication, what side-effects
to expect, how to manage them, what side-effects are dangerous and
should be reported, etc. Patients are not compliant for many reasons,
and pharmacists are well equipped for effective one-to-one discussions
that produce positive results. Peer-reviewed studies in published liter-
ature consistently document the effectiveness of increasing direct
interactions between pharmacists and patients. In fact, the e vidence
was so compelling that the Centers for Medicaid and Medicare included
Medication Therapy Management as a mandatory element in Medicare Part D
Prescription Drug Plans. CMM represents a logical progression. Under
CMM, only at-risk patients receive the additional service. Patients are
identified by their treating physicians and referred to an individual
pharmacist with whom the treating physician has developed a written
protocol for a particular patient related to a particular disease or
diseases. As Value-Based payment methodologies evolve and quality is
increasingly measured by therapeutic outcomes in defined patient popu-
lations, the need for Comprehensive Medication Management services by
pharmacists will become more and more apparent. In fact, QARR and HEDIS
measures currently include many directly concerned with medication
adherence, for example: medication management for people with asthma,
statin therapy for patients with diabetes, persistence of beta-blocker
treatment after a heart attack, antidepressant medication management,
and adherence to antipsychotic medications for people with schizophre-
nia. Comprehensive Medication Management as described in the bill
applies to pharmacists in community settings as well as pat ients with
chronic medical conditions and their treating physicians who have
relationships with local pharmacists. The protocols envisioned in this
proposal will deal with common conditions such as asthma, diabetes,
hypertension and hypercholesterolemia. This legislation represents a
modest and logical extension to the services that pharmacists in commu-
nity practice settings can provide if they meet the additional quali-
fications included in the bill. Finally, under current Education Law
pharmacists employed in hospitals who meet additional qualification
requirements receive a credential from the Education Department author-
izing them to enter into collaborative agreements with physicians in
hospitals. This bill removes the sunset on this section of law which has
been in place since 2011, making it permanent.

 
PRIOR LEGISLATIVE HISTORY:

2017-2018 A.8664-A/S.7682

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

This legislation is expected to result in a savings for the State under
Medicaid and other public programs.

 
EFFECTIVE DATE:
This act shall take effect immediately, provided that sections one and
two of this act shall take effect on the one hundred eightieth day after
it shall have become a law provided, that, effective immediately, the
addition, amendment and/or repeal of any rule or regulation necessary
for the implementation of this act on its effective date is authorized
and directed to be made and completed on or before such effective date.

2019-S5296 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5296
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                              April 23, 2019
                                ___________
 
 Introduced  by  Sen. BRESLIN -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the education law, in relation
   to comprehensive medication management; and to amend chapter 21 of the
   laws of 2011 amending the education law relating to authorizing  phar-
   macists  to  perform collaborative drug therapy management with physi-
   cians in certain settings, in relation to  making  the  provisions  of
   such chapter permanent
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding  a  new  article
 29-H to read as follows:
                               ARTICLE 29-H
                    COMPREHENSIVE MEDICATION MANAGEMENT
 SECTION 2999-EE. COMPREHENSIVE MEDICATION MANAGEMENT.
   §  2999-EE.  COMPREHENSIVE  MEDICATION  MANAGEMENT. 1. DEFINITIONS. AS
 USED IN THIS ARTICLE, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEAN-
 INGS:
   (A) QUALIFIED PHARMACIST. THE TERM "QUALIFIED PHARMACIST" SHALL MEAN A
 PHARMACIST WHO MAINTAINS A  CURRENT  UNRESTRICTED  LICENSE  PURSUANT  TO
 ARTICLE ONE HUNDRED THIRTY-SEVEN OF THE EDUCATION LAW, WHO HAS A MINIMUM
 OF  TWO  YEARS  OF EXPERIENCE IN PATIENT CARE AS A PRACTICING PHARMACIST
 WITHIN THE LAST FIVE YEARS, AND WHO HAS DEMONSTRATED COMPETENCY  IN  THE
 MEDICATION  MANAGEMENT  OF  PATIENTS WITH A CHRONIC DISEASE OR DISEASES,
 INCLUDING, BUT NOT LIMITED TO, THE COMPLETION OF ONE  OR  MORE  PROGRAMS
 WHICH  ARE  ACCREDITED  BY THE ACCREDITATION COUNCIL FOR PHARMACY EDUCA-
 TION, RECOGNIZED BY THE  EDUCATION  DEPARTMENT  AND  ACCEPTABLE  TO  THE
 PATIENT'S TREATING PHYSICIAN.
   (B)  PATIENT  CARE.  THE  TERM "PATIENT CARE" SHALL MEAN ASSESSING THE
 APPROPRIATENESS OF PRESCRIPTION AND NON-PRESCRIPTION DRUGS FOR  INDIVID-
 UAL PATIENTS BASED ON AN ASSESSMENT OF THE PATIENT'S MEDICATION HISTORY,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD00591-01-9

 S. 5296                             2
 
 MEDICATION  EXPERIENCE  INCLUDING  BELIEFS,  CONCERNS, UNDERSTANDING AND
 EXPECTATIONS, THE CLINICAL  GOALS  OF  THERAPY,  POTENTIAL  DRUG-TO-DRUG
 INTERACTIONS  OR  OTHER  MEDICATION SAFETY CONCERNS, RECOMMENDATIONS FOR
 ADHERENCE AND CONSULTING WITH A PATIENT OR CAREGIVER.
   (C) COMPREHENSIVE MEDICATION MANAGEMENT. THE TERM "COMPREHENSIVE MEDI-
 CATION MANAGEMENT" SHALL MEAN A PROGRAM CONDUCTED BY A QUALIFIED PHARMA-
 CIST  THAT  ENSURES  A  PATIENT'S  MEDICATIONS,  WHETHER PRESCRIPTION OR
 NONPRESCRIPTION, ARE INDIVIDUALLY ASSESSED TO DETERMINE THAT EACH  MEDI-
 CATION  IS APPROPRIATE FOR THE PATIENT, EFFECTIVE FOR THE MEDICAL CONDI-
 TION, SAFE GIVEN THE COMORBIDITIES AND OTHER  MEDICATIONS  BEING  TAKEN,
 AND  ABLE  TO BE TAKEN BY THE PATIENT AS INTENDED. COMPREHENSIVE MEDICA-
 TION MANAGEMENT CONDUCTED BY A QUALIFIED PHARMACIST SHALL INCLUDE  SHAR-
 ING  OF APPLICABLE PATIENT CLINICAL INFORMATION WITH THE TREATING PHYSI-
 CIAN AS SPECIFIED IN A COMPREHENSIVE MEDICATION MANAGEMENT PROTOCOL.
   (D) COMPREHENSIVE MEDICATION MANAGEMENT PROTOCOL. THE TERM "COMPREHEN-
 SIVE MEDICATION MANAGEMENT  PROTOCOL"  SHALL  MEAN  A  WRITTEN  DOCUMENT
 PURSUANT  TO  AND  CONSISTENT  WITH  ANY  APPLICABLE  STATE  AND FEDERAL
 REQUIREMENTS, THAT IS ENTERED INTO VOLUNTARILY BY A  PHYSICIAN  LICENSED
 PURSUANT  TO  ARTICLE  ONE HUNDRED THIRTY-ONE OF THE EDUCATION LAW AND A
 QUALIFIED PHARMACIST WHICH ADDRESSES A CHRONIC DISEASE  OR  DISEASES  AS
 DETERMINED  BY  THE TREATING PHYSICIAN AND THAT DESCRIBES THE NATURE AND
 SCOPE  OF  THE  COMPREHENSIVE  MEDICATION  MANAGEMENT  SERVICES  TO   BE
 PERFORMED BY THE QUALIFIED PHARMACIST, IN ACCORDANCE WITH THE PROVISIONS
 OF  THIS ARTICLE.  COMPREHENSIVE MEDICATION MANAGEMENT PROTOCOLS BETWEEN
 LICENSED PHYSICIANS AND QUALIFIED PHARMACISTS SHALL BE MADE AVAILABLE TO
 THE DEPARTMENT FOR REVIEW AND TO ENSURE COMPLIANCE  WITH  THIS  ARTICLE,
 UPON REQUEST.
   2.  AUTHORIZATION  TO  ESTABLISH  COMPREHENSIVE  MEDICATION MANAGEMENT
 PROTOCOLS. A PHYSICIAN LICENSED PURSUANT TO ARTICLE ONE HUNDRED  THIRTY-
 ONE  OF THE EDUCATION LAW SHALL BE AUTHORIZED TO VOLUNTARILY ESTABLISH A
 COMPREHENSIVE MEDICATION MANAGEMENT PROTOCOL WITH A QUALIFIED PHARMACIST
 TO PROVIDE COMPREHENSIVE MEDICATION MANAGEMENT SERVICES  FOR  A  PATIENT
 WHO  HAS  NOT MET CLINICAL GOALS OF THERAPY, IS AT RISK FOR HOSPITALIZA-
 TION OR FOR WHOM THE PHYSICIAN DEEMS IT IS NECESSARY TO RECEIVE  COMPRE-
 HENSIVE MEDICATION MANAGEMENT SERVICES.  PARTICIPATION BY THE PATIENT IN
 COMPREHENSIVE MEDICATION MANAGEMENT SERVICES SHALL BE VOLUNTARY.
   3.  SCOPE  OF  COMPREHENSIVE  MEDICATION MANAGEMENT PROTOCOLS. UNDER A
 COMPREHENSIVE MEDICATION MANAGEMENT  PROTOCOL,  A  QUALIFIED  PHARMACIST
 SHALL BE PERMITTED TO:
   (A)  ADJUST  OR  MANAGE  A  DRUG REGIMEN OF A PATIENT, PURSUANT TO THE
 PATIENT SPECIFIC ORDER OR PROTOCOL ESTABLISHED BY THE PATIENT'S TREATING
 PHYSICIAN, WHICH MAY  INCLUDE  ADJUSTING  DRUG  STRENGTH,  FREQUENCY  OF
 ADMINISTRATION  OR  ROUTE OF ADMINISTRATION.  ADJUSTING THE DRUG REGIMEN
 SHALL NOT INCLUDE SUBSTITUTING  OR  SELECTING  A  DIFFERENT  DRUG  WHICH
 DIFFERS  FROM THAT INITIALLY PRESCRIBED BY THE PATIENT'S TREATING PHYSI-
 CIAN UNLESS SUCH SUBSTITUTION IS EXPRESSLY  AUTHORIZED  IN  THE  WRITTEN
 ORDER  OR  PROTOCOL. THE QUALIFIED PHARMACIST SHALL BE REQUIRED TO IMME-
 DIATELY DOCUMENT IN THE PATIENT'S MEDICAL RECORD  CHANGES  MADE  TO  THE
 PATIENT'S  DRUG  THERAPY. THE PATIENT'S TREATING PHYSICIAN MAY PROHIBIT,
 BY WRITTEN INSTRUCTION, ANY ADJUSTMENT OR CHANGE IN THE  PATIENT'S  DRUG
 REGIMEN BY THE QUALIFIED PHARMACIST;
   (B)  EVALUATE AND, ONLY IF SPECIFICALLY AUTHORIZED BY THE PROTOCOL AND
 ONLY TO THE EXTENT NECESSARY TO DISCHARGE THE RESPONSIBILITIES SET FORTH
 IN THIS ARTICLE, ORDER DISEASE STATE LABORATORY  TESTS  RELATED  TO  THE
 DRUG  THERAPY  MANAGEMENT  FOR  THE SPECIFIC CHRONIC DISEASE OR DISEASES
 SPECIFIED WITHIN THE WRITTEN AGREEMENT OR PROTOCOL;

 S. 5296                             3
 
   (C) ONLY IF SPECIFICALLY AUTHORIZED BY THE WRITTEN ORDER  OR  PROTOCOL
 AND  ONLY  TO THE EXTENT NECESSARY TO DISCHARGE THE RESPONSIBILITIES SET
 FORTH IN THIS ARTICLE, ORDER OR PERFORM ROUTINE PATIENT MONITORING FUNC-
 TIONS AS MAY BE NECESSARY IN THE DRUG THERAPY MANAGEMENT, INCLUDING  THE
 COLLECTING  AND REVIEWING OF PATIENT HISTORIES, AND ORDERING OR CHECKING
 PATIENT VITAL  SIGNS,  INCLUDING  PULSE,  TEMPERATURE,  BLOOD  PRESSURE,
 WEIGHT AND RESPIRATION; AND
   (D)  ACCESS  THE  COMPLETE  PATIENT  MEDICAL  RECORD MAINTAINED BY THE
 TREATING PHYSICIAN WITH WHOM THE QUALIFIED PHARMACIST HAS THE COMPREHEN-
 SIVE MEDICATION MANAGEMENT PROTOCOL AND DOCUMENT  ANY  ADJUSTMENTS  MADE
 PURSUANT TO THE PROTOCOL IN THE PATIENT'S MEDICAL RECORD AND SHALL NOTI-
 FY  THE  PATIENT'S  TREATING  PHYSICIAN  OF  ANY ADJUSTMENTS IN A TIMELY
 MANNER ELECTRONICALLY OR BY OTHER MEANS.
   (E) UNDER NO CIRCUMSTANCES, SHALL THE QUALIFIED PHARMACIST BE  PERMIT-
 TED  TO  DELEGATE  COMPREHENSIVE  MEDICATION  MANAGEMENT SERVICES TO ANY
 OTHER LICENSED PHARMACIST OR OTHER PHARMACY PERSONNEL.
   4. MEDICATION ADJUSTMENTS. ANY  MEDICATION  ADJUSTMENTS  MADE  BY  THE
 QUALIFIED PHARMACIST PURSUANT TO THE COMPREHENSIVE MEDICATION MANAGEMENT
 PROTOCOL  INCLUDING  ADJUSTMENTS IN DRUG STRENGTH, FREQUENCY OR ROUTE OF
 ADMINISTRATION, OR INITIATION OF A DRUG WHICH DIFFERS FROM THAT INITIAL-
 LY PRESCRIBED AND AS DOCUMENTED IN THE PATIENT'S MEDICAL RECORD SHALL BE
 DEEMED AN ORAL PRESCRIPTION AUTHORIZED BY  AN  AGENT  OF  THE  PATIENT'S
 TREATING  PHYSICIAN  AND  SHALL  BE  DISPENSED  CONSISTENT  WITH SECTION
 SIXTY-EIGHT HUNDRED TEN OF THE EDUCATION LAW. FOR THE PURPOSES  OF  THIS
 ARTICLE,  A  PHARMACIST  WHO  IS NOT AN EMPLOYEE OF THE PHYSICIAN MAY BE
 AUTHORIZED TO SERVE AS AN AGENT OF THE PHYSICIAN.
   5. REFERRALS. A PHYSICIAN LICENSED PURSUANT  TO  ARTICLE  ONE  HUNDRED
 THIRTY-ONE OF THE EDUCATION LAW WHO HAS RESPONSIBILITY FOR THE TREATMENT
 AND CARE OF A PATIENT FOR A CHRONIC DISEASE OR DISEASES AS DETERMINED BY
 THE  PHYSICIAN  MAY  REFER  THE  PATIENT  TO  A QUALIFIED PHARMACIST FOR
 COMPREHENSIVE MEDICATION MANAGEMENT SERVICES, PURSUANT TO THE COMPREHEN-
 SIVE MEDICATION MANAGEMENT PROTOCOL THAT THE PHYSICIAN  HAS  ESTABLISHED
 WITH  THE  QUALIFIED  PHARMACIST. THE PROTOCOL AGREEMENT SHALL AUTHORIZE
 THE PHARMACIST TO SERVE AS AN AGENT OF THE PHYSICIAN AS DEFINED  BY  THE
 PROTOCOL.  SUCH  REFERRAL  SHALL  BE DOCUMENTED IN THE PATIENT'S MEDICAL
 RECORD.
   6. PATIENT PARTICIPATION. PARTICIPATION  IN  COMPREHENSIVE  MEDICATION
 MANAGEMENT  SERVICES  SHALL  BE  VOLUNTARY, AND NO PATIENT, PHYSICIAN OR
 PHARMACIST SHALL BE REQUIRED TO PARTICIPATE. THE REFERRAL OF  A  PATIENT
 FOR COMPREHENSIVE MEDICATION MANAGEMENT SERVICES AND THE PATIENT'S RIGHT
 TO CHOOSE TO NOT PARTICIPATE SHALL BE DISCLOSED TO THE PATIENT.  COMPRE-
 HENSIVE  MEDICATION MANAGEMENT SERVICES SHALL NOT BE UTILIZED UNLESS THE
 PATIENT OR THE PATIENT'S AUTHORIZED REPRESENTATIVE CONSENTS, IN WRITING,
 TO SUCH SERVICES. SUCH CONSENT SHALL BE NOTED IN THE  PATIENT'S  MEDICAL
 RECORD.  IF  THE  PATIENT OR THE PATIENT'S AUTHORIZED REPRESENTATIVE WHO
 CONSENTED CHOOSES TO NO LONGER PARTICIPATE  IN  SUCH  SERVICES,  AT  ANY
 TIME,  THE  SERVICES  SHALL BE DISCONTINUED AND IT SHALL BE NOTED IN THE
 PATIENT'S MEDICAL RECORD.
   § 2. The education law is amended by adding a new  section  6801-b  to
 read as follows:
   §  6801-B.  COMPREHENSIVE  MEDICATION  MANAGEMENT.  1. AS USED IN THIS
 SECTION:
   (A) "COMPREHENSIVE MEDICATION MANAGEMENT" SHALL MEAN A PROGRAM FOR THE
 MANAGEMENT OF CHRONIC DISEASE OR DISEASES THAT ENSURES A PATIENT'S MEDI-
 CATIONS,  WHETHER  PRESCRIPTION  OR  NONPRESCRIPTION,  ARE  INDIVIDUALLY
 ASSESSED  TO  DETERMINE  THAT  EACH  MEDICATION  IS  APPROPRIATE FOR THE

 S. 5296                             4
 
 PATIENT, EFFECTIVE FOR THE MEDICAL CONDITION, SAFE GIVEN THE  COMORBIDI-
 TIES  AND  OTHER  MEDICATIONS  BEING  TAKEN, AND ABLE TO BE TAKEN BY THE
 PATIENT AS INTENDED; AND
   (B)  "COMPREHENSIVE MEDICATION MANAGEMENT PROTOCOL" SHALL MEAN A WRIT-
 TEN DOCUMENT, PURSUANT TO AND CONSISTENT WITH ANY  APPLICABLE  STATE  OR
 FEDERAL  REQUIREMENTS,  THAT  IS ENTERED INTO VOLUNTARILY BY A PHYSICIAN
 LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE OF THIS TITLE AND  A
 LICENSED  PHARMACIST  WHO MEETS THE QUALIFICATION REQUIREMENTS SPECIFIED
 IN ARTICLE TWENTY-NINE-H OF THE PUBLIC  HEALTH  LAW  WHICH  ADDRESSES  A
 CHRONIC  DISEASE  OR  DISEASES  AS  DETERMINED BY THE PHYSICIAN AND THAT
 DESCRIBES THE NATURE AND SCOPE OF THE COMPREHENSIVE  MEDICATION  MANAGE-
 MENT  SERVICE TO BE PERFORMED BY THE QUALIFIED PHARMACIST. COMPREHENSIVE
 MEDICATION MANAGEMENT PROTOCOLS BETWEEN LICENSED PHYSICIANS  AND  QUALI-
 FIED  PHARMACISTS  SHALL  BE MADE AVAILABLE TO THE DEPARTMENT FOR REVIEW
 AND TO ENSURE COMPLIANCE WITH THIS ARTICLE, UPON REQUEST.
   2. A LICENSED PHARMACIST QUALIFIED PURSUANT TO  ARTICLE  TWENTY-NINE-H
 OF  THE  PUBLIC  HEALTH  LAW  IS  AUTHORIZED TO SERVE AS AN AGENT OF THE
 PHYSICIAN WHEN EXECUTING THE TERMS OF THE WRITTEN COMPREHENSIVE  MEDICA-
 TION  MANAGEMENT  PROTOCOL  AS ESTABLISHED BY THE LICENSED PHYSICIAN FOR
 THE MANAGEMENT OF PATIENTS WITH A CHRONIC DISEASE OR DISEASES.
   § 3. Section 5 of chapter 21 of the laws of 2011, amending the  educa-
 tion  law  relating  to authorizing pharmacists to perform collaborative
 drug therapy management with physicians in certain settings, as  amended
 by section 5 of part DD of chapter 57 of the laws of 2018, is amended to
 read as follows:
   § 5. This act shall take effect on the one hundred twentieth day after
 it  shall  have become a law[, provided, however, that the provisions of
 sections two, three, and four of this act shall  expire  and  be  deemed
 repealed July 1, 2020]; provided, however, that the amendments to subdi-
 vision  1  of  section  6801 of the education law made by section one of
 this act shall be subject to the expiration and reversion of such subdi-
 vision pursuant to section 8 of chapter 563 of the laws  of  2008,  when
 upon  such  date  the provisions of section one-a of this act shall take
 effect; provided, further, that  effective  immediately,  the  addition,
 amendment  and/or  repeal  of  any  rule or regulation necessary for the
 implementation of this act on its  effective  date  are  authorized  and
 directed to be made and completed on or before such effective date.
   §  4.  This  act shall take effect immediately, provided that sections
 one and two of this act shall take effect on the one  hundred  eightieth
 day  after it shall have become a law.  Effective immediately, the addi-
 tion, amendment and/or repeal of any rule or  regulation  necessary  for
 the  implementation of this act on its effective date are authorized and
 directed to be made and completed on or before such effective date.

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