Enacts comprehensive provisions to curtail the incidence of asthma and other respiratory diseases

Section 2: (Part A) Adds a new Public Health Law Article 27-BB as follows: Creates a new Public Health Law section 2725 to create an Asthma disease management and control program. The purpose of the program is to promote asthma disease management and education and outreach about asthma to people who suffer from asthma and their families, health care providers, and the general public.

Creates a new Public Health Law (PHL) section 2726 to require the Department of Health (DOH) to study the incidence and prevalence of asthma in New York state including current disease management practices.

Such study shall include the cause and nature of the disease, behavioral and environmental triggers, an assessment of the need for patient-centered case management to meet specific physical and environmental needs of patients, outcome evaluations and an assessment of the ability of providers to systemically instruct and develop asthma management plans for patients and frequently review with patients and their families how to manage and control their asthma. DOH shall also gather demographic information for monitoring the occurrence, frequency, incidence, cause, effect and severity of asthma. The gathered data can be used for research purposes and the Department of Health will develop a unique and confidential identifier to be used in the collection of patient information for the purposes described above. Information gathered pursuant to the Asthma incident reporting provisions of PHL Article 24-F can be used for the preparation of any reports contained in this Part A of this bill.

Creates a new PHL section § 2727 to require the Commissioner to submit an annual report, commencing January first, after the bill is enacted and continue annually thereafter. The report shall include the status and accomplishments of the program and provide recommendations to the governor, the temporary president and the minority leader of the senate, and the speaker and the minority leader of the assembly.

Section 3: (Part B) Adds a new Article 13-I to the Public Health Law to establish a program to prevent in-utero exposure to tobacco smoke. Under this program, health care providers, health insurers, and pregnancy programs shall distribute information on the adverse effects of smoking during pregnancy, both first hand and second hand smoke. In-utero exposure to tobacco smoke leads to lower birth rates, higher incidences of asthma and childhood obesity, and can lead to cognitive and developmental damage to the child. Under this article, individualized smoking cessation programs would be established to increase the success rates for mothers who smoke tobacco or live in households where others smoke tobacco. This program will help to reduce the incidence of asthma.

Section 4: (Part C) Adds a new Public Health Law Article 24-F to establish an Asthma Incidence Reporting program that is similar to one that already exists to map the incidence of cancer in New York. The bill defines asthma attacks as a reportable disease that physicians, other health care providers, hospitals, and other health care facilities are required to report to the Health Department (DOH). The Department shall establish what constitutes a reportable event, so that information received by DOH can be used to track where and who is affected by asthma attacks. Among the demographic information to be collected and sorted for those afflicted with asthma includes by age, residence, location, proximity to industrial and transportation sites, race, and by school.

Section 5: (Part D) 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 chronic conditions related to emphysema, chronic bronchitis, and other respiratory diseases.

Section 6: (Part E) Expands provisions from section 1399-0-1 of the Public health law added by chapter 102 of the laws of 2013 to regulate smoking in certain indoor areas open to the public to also include certain outdoor areas open to the public. Under this provision, it is prohibited to smoke within 15 feet from the entrance or exit of public buildings or private buildings that contain state or municipal offices or educational facilities. The underlying purpose of this provision is to ensure that a person who needs to conduct public business or students who enter into elementary and secondary schools, that are located in private buildings, are not exposed to second-hand tobacco smoke that may trigger an asthma episode or attack.

Section 7: (Part F) Adds a new Education Law section 3001-e to require the Education Commissioner, in consultation with the Commissioner of Health, to establish standards for the training of teachers and other appropriate personnel in identifying and responding to asthma emergencies.

Section 8: (Part G) Adds Real Property Law section 235-h to require that every rental agreement for an apartment in a building that has four units or more must disclose the smoking policy of such building, The landlord is still free to either fully ban, partially ban, or generally permit smoking in such building's apartments and common areas. It is the purpose of this section to encourage landlords to think about the building's smoking policy and to give tenants notice of such policies. This in turn may encourage non-smoker tenants to seek out apartment buildings that have a no smoking policy and encourage landlords to at least minimize smoke exposure to those tenants who do not smoke to increase the marketability of their apartments. While this bill is a comprehensive bill to address asthma issues, there is a correlation between those who are exposed, either voluntary or otherwise, to first and second hand tobacco smoke, and asthma. It would be difficult to address asthma issues without looking at the incidence of tobacco smoking and exposing, particularly children, to such conditions that can trigger asthma attacks and increase the incidence of asthma conditions generally.

Section 9: (Part H) Adds a new Education Law section 1527-a to expand the concept and provisions contained in Chapter 670-of the Laws of 2007 which mandated that the Department of Education promulgate rules and regulations to minimize the discharge of school bus exhaust on school grounds when such vehicles were loading and unloading students. The underlying purpose of this law was to minimize diesel exhaust from idling school busses to help lower the incidence of asthma and reduce the number of asthma attacks sustained by school children. This bill proposes to expand the prohibition on idling school busses to include all other private vehicles that deliver or discharge students on school grounds. While many students are transported to and from school by school busses, many others are transported by family members individually to school. The standard operating procedure for most schools is that a separate line of cars is established and the 'students must remain in those private vehicles until a designated time, at which time the students are discharged or picked up. During the wait time, many private vehicles continue to operate and discharge emissions which can lead to an increased incidence of asthma conditions or a full fledged asthma attack. This provision encourages such private vehicles to turn off their engines to reduce the amount of emissions and triggers for asthma attacks.

Section 10: (Part I) Amends Education Law section 923 to expand the number of students who can have and use an inhaler at school to maintain appropriate airflow to their lungs or suppress an asthmatic attack. The medical community maintains that it is better to monitor and address those who are susceptible to asthma conditions and treat such conditions before an asthmatic attack occurs, This bill increases the number of persons who can have and use an inhaler at school to include not only those who have a 'severe asthmatic condition", to also include those who have a "moderately severe asthmatic condition" or have other potentially life-threatening respiratory illnesses".

Section 2 of this Part J also adds a new Education Law section 921 to authorize school districts to posses and use nebulizers for those students that need such treatments. As the number and severity asthma attacks increases in the student body, it is important that such students have access not only to their inhalers, but nebulizers as well. The bill provides safeguards to ensure that only students that have a physician's treatment plan can use such nebulizers on school grounds. Further, such nebulizer treatment must be monitored by the school nurse or other person authorized by regulation.

Section 11: (Part J) Amends Environmental Conservation Law section 33-0303 (7) to expand the scope of this section of law which empowers the Commissioner of Environmental Conservation (DEC) to promulgate rules aria guidance on the use pesticide alternatives to minimize pesticide applications in day care centers and in schools. This proposed provision allows DEC to identify pesticide alternatives that can help to minimize the incidence of asthma attacks in public buildings and homes, while still effectively controlling the targeted pest or organization. Studies have shown that higher levels of cockroach and mouse allergens can increase the incidence of asthma episodes or attacks. To control these conditions, the heightened use of pesticides is generally required to keep such pests under control. However, the application of pesticides also, can increase the incidence of asthma episodes or attacks. Hence, lower levels of pesticide applications are a desired to minimize asthma conditions. This provision asks DEC, in consultation with DOH, to advise those who apply pesticides in homes and public buildings to use pesticides that can help to minimize targeted pests, but also which does not, as best as possible, heighten the incidence of asthma conditions or attacks. It is important to embody in the law the conflicting goals of pesticide use, while still considering its effect asthma conditions.

Section 12: (Part K) Adds a new Public Buildings Law section 143 to curtail the use of cleaning materials or chemicals that can induce or trigger asthma attacks. The superintendent of every state public building and every public transportation facility operated by a public authority, public benefit corporation or municipality shall curtail, to the best of their ability, the use of cleaning materials or chemicals that may cause their the building's cleaning staff or the general public to have an asthma attack or increase the incidence of such an asthma condition. In determining which cleaning products and concentration of cleaning chemicals that may trigger an asthma attack or increase the incidence of an asthmatic condition for cleaning staff or the general public, DOH shall promulgate a list of such chemicals to guide the actions of building superintendents.

Justification

Asthma is a chronic, potentially life-threatening, respiratory illness that affects over a million New Yorkers, including many who arc children and adolescents. Asthma i3 also directly linked to large and growing inpatient and outpatient bills paid for by Medicaid and other health care payers, which in most cases could be avoided through early education and treatment of this condition. Asthma is the most common chronic disorder in children and adolescents and is responsible for approximately 10 million missed school days each year which is three times the amount for children without this debilitating ailment. In recent years, asthma has become the leading cause of hospitalization among children in New York and since 1980, the death rate among sufferers has increased a staggering 50%. In one area of the Bronx known as "Asthma Alley" the rate of asthma sufferers is 7 1/2 times that of the national average.

Research and preventive efforts need to be increased. This is because numerous studies show that early education, screening, and treatment is a very cost effective method to address this growing public health problem. Establishing a comprehensive statewide asthma management program which coordinates the efforts of individuals, families, health care providers, schools and community-based organizations would help New York track the disease, better understand its causes and triggers, and direct asthma education and preventive care to the children and families who need it the most.

Legislative history

2014 - S. 2363 - Referred to Health 2012 - S. 5863 Referred to Health

Fiscal implications

Some of the provisions of this bill may be subject to fiscal appropriation. EFFECTIVE DATE : See the individual effective dates for each Part of this bill.