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A02200 Summary:

BILL NOA02200
 
SAME ASSAME AS S00836
 
SPONSORMcDonald
 
COSPNSR
 
MLTSPNSR
 
Rpld §341-a, amd §§3217-a & 4324, Ins L (as proposed in S.4620-C & A.5411-D); amd §4408, Pub Health L
 
Provides for patient prescription pricing transparency; requires certain insurers or pharmacy benefit managers to furnish required cost, benefit and coverage data upon request of the insured, the insured's health care provider or an authorized third party.
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A02200 Actions:

BILL NOA02200
 
01/23/2023referred to insurance
01/31/2023reported referred to rules
01/31/2023reported
01/31/2023rules report cal.70
01/31/2023ordered to third reading rules cal.70
02/01/2023passed assembly
02/01/2023delivered to senate
02/01/2023REFERRED TO RULES
02/13/2023SUBSTITUTED FOR S836
02/13/20233RD READING CAL.45
02/13/2023PASSED SENATE
02/13/2023RETURNED TO ASSEMBLY
03/03/2023delivered to governor
03/03/2023signed chap.63
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A02200 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2200
 
SPONSOR: McDonald
  TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to patient prescription pricing transparency; and to repeal certain provisions of the insurance law related thereto   PURPOSE OR GENERAL IDEA OF BILL: The purpose of this bill is to make amendments to Chapter 826 of the Laws of 2022 relating to the Patient Rx Information and Choice Expansion Act (PRICE Act).   SUMMARY OF PROVISIONS: Sections 1 exempts Medicaid from the Patient Rx Information and Choice Expansion Act (PRICE Act) which requires all health plans, upon request of their insured or enrollee, provider, or a third-party on their behalf, to furnish cost, benefit, and coverage data of prescription drugs. This section also provides technical amendments and moves the PRICE Act to a section of the insurance law related to insurance contracts. Sections 3-4 adds conforming language to Article 43 (Non-Profits) and Article 44 (HMOs) of the Insurance Law. Section 5 provides a severability clause. Section 6 provides the effective date.   JUSTIFICATION: This bill seeks to address affordability and transparency issues that affect prescription drug use and adherence. The out-of-pocket cost burden for medically necessary treatments for patients can negatively impact the likelihood of beginning treatment and adherence, leading to overall drug abandonment rates. In addition, the use of high deductible plans is growing resulting in increased costs for patients for medically necessary treatments. Patient non-adherence to necessary prescribed medications is associated with poor clinical outcomes, progression of disease, and an estimated burden of billions per year in avoidable direct health care costs. Between $100 and $300 billion of avoidable health care costs have been attributed to non-adherence in the U.S. annually, representing 3% to 10% of total US health care costs. The Centers for Medicare and Medicaid Services (CMS) have found that health plans and entities acting on their behalf may have misaligned incentives driving utilization of higher cost medicines and hindering patient choice to lower cost options due to a lack of price transparency. Per CMS, prescription price transparency is critical to lowering overall drug costs and patient out-of-pocket costs and supports improved medication adherence. At a time when patients are being required to pay more and more out-of-pocket for healthcare, they need access to real-time, patient-specific information via means of their choosing. To achieve cost savings, patients must understand their drug benefit coverage and payment considerations for drugs on and off a plan's formulary, including lower cost clinical and therapeutic alterna- tives. Chapter 826 of the Laws of 2022 established the Patient Rx Information and Choice Expansion Act (PRICE Act) which requires all health plans, upon request of their insured or enrollee, provider, or a third-party on their behalf, to furnish cost, benefit, and coverage data of prescription drugs. This Chapter amendment exempts Medicaid from the PRICE Act and provides technical amendments.   PRIOR LEGISLATIVE HISTORY: This is a new bill.   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None noted.   EFFECTIVE DATE: This act shall take effect on the same date and in the same manner as a chapter of the laws of 2022 amending the insurance law relating to enacting the "patient Rx information and choice expansion act", as proposed in legislative bills numbers S.4620-C and A.5411-D, takes effect.
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A02200 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          2200
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 23, 2023
                                       ___________
 
        Introduced by M. of A. McDONALD -- read once and referred to the Commit-
          tee on Insurance
 
        AN ACT to amend the insurance law and the public health law, in relation
          to  patient  prescription  pricing transparency; and to repeal certain
          provisions of the insurance law related thereto

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Subsection 341-a of the insurance law, as added by a chap-
     2  ter of the laws of 2022 amending the insurance law relating to  enacting
     3  the  "patient  Rx  information and choice expansion act", as proposed in
     4  legislative bills numbers S. 4620-C and A. 5411-D, is REPEALED.
     5    § 2. Section 3217-a of the insurance law is amended by  adding  a  new
     6  subsection (g) to read as follows:
     7    (g) (1) As used in this subsection:
     8    (A)  "Pharmacy  benefit  manager" shall have the meanings set forth in
     9  section two hundred eighty-a of the public health law.
    10    (B) "Cost-sharing information" means the amount an insured is required
    11  to pay to receive a drug that is covered under the  insured's  insurance
    12  policy.
    13    (C)  "Covered/coverage"  means  those health care services to which an
    14  insured is entitled under the terms of the insurance policy.
    15    (D) "Electronic health record" means a digital version of a  patient's
    16  paper  chart  and  medical  history  that  makes  information  available
    17  instantly and securely to authorized users.
    18    (E) "Electronic prescribing system" means a system that enables  pres-
    19  cribers  to  enter prescription information into a computer prescription
    20  device and securely transmit the  prescription  to  pharmacies  using  a
    21  special software program and connectivity to a transmission network.
    22    (F)  "Electronic  prescription"  means  an  electronic prescription as
    23  defined in section thirty-three hundred two of the public health law.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04034-01-3

        A. 2200                             2
 
     1    (G) "Prescriber" means a health care provider  licensed  to  prescribe
     2  medication or medical devices in this state.
     3    (H)   "Real-time   benefit   tool"   or  "RTBT"  means  an  electronic
     4  prescription decision support tool that: (i) is capable  of  integrating
     5  with  prescribers' electronic prescribing system and, if feasible, elec-
     6  tronic health record systems; and (ii) complies with the technical stan-
     7  dards adopted by an American National Standards Institute (ANSI) accred-
     8  ited standards development organization.
     9    (I) "Authorized third party"  shall  include  a  third  party  legally
    10  authorized  under  state  or  federal  law subject to a Health Insurance
    11  Portability and Accountability Act (HIPAA) business associate agreement.
    12    (2) The provisions of this section shall not apply to any health  plan
    13  that  exclusively  serves  individuals enrolled pursuant to a federal or
    14  state insurance affordability program, including the medical  assistance
    15  program  under  title eleven of article five of the social services law,
    16  child health plus under section twenty-five hundred eleven of the public
    17  health law, the basic health program under section three hundred  sixty-
    18  nine-gg  of  the social services law, or a plan providing services under
    19  title XVIII of the federal social security act.
    20    (3) An insurer subject to this article  or  pharmacy  benefit  manager
    21  shall,  upon request of the insured, the insured's health care provider,
    22  or an authorized third party on the insured's behalf, made to the insur-
    23  er or pharmacy benefit manager, furnish the cost, benefit, and  coverage
    24  data  required  by  this subsection to the insured, the insured's health
    25  care provider, or the authorized third party and shall ensure that  such
    26  data  is: (A) current no later than one business day after any change to
    27  the cost, benefit, or coverage data is made;  (B)  provided  through  an
    28  RTBT when the request is made by the insured's health care provider; and
    29  (C) in a format that is easily accessible to the requestor.
    30    (4)  When  providing  the  data  required  by  paragraph three of this
    31  subsection, the insurer or pharmacy benefit  manager  shall  use  estab-
    32  lished industry content and transport standards published by:
    33    (A)  a  standards  developing  organization accredited by the American
    34  National Standards Institute (ANSI), including, the National Council for
    35  Prescription Drug Programs (NCPDP), ASC X12, Health Level 7; or
    36    (B) a relevant federal or state governing body, including  the  Center
    37  for Medicare & Medicaid Services or the Office of the National Coordina-
    38  tor for Health Information Technology; or
    39    (C)  another format deemed acceptable to the department which provides
    40  the data prescribed in paragraph three of this  subsection  and  in  the
    41  same timeliness as required by this section.
    42    (5)  A  facsimile  shall  not  be  considered an acceptable electronic
    43  format pursuant to this subsection.
    44    (6)  Upon  a  request  made  pursuant  to  paragraph  three  of   this
    45  subsection,  the  insurer  or pharmacy benefit manager shall provide the
    46  following data for any drug covered under the insured's insurance  poli-
    47  cy:
    48    (A) insured-specific eligibility information;
    49    (B)  insured-specific  prescription  cost  and  benefit  data, such as
    50  applicable formulary, benefit, coverage and cost-sharing  data  for  the
    51  prescribed  drug and clinically-appropriate alternatives, when appropri-
    52  ate;
    53    (C) insured-specific cost-sharing information that describes  variance
    54  in  cost-sharing based on the pharmacy dispensing the prescribed drug or
    55  its alternatives, and in relation to the insured's benefit; and
    56    (D) applicable utilization management requirements.

        A. 2200                             3
 
     1    (7) Any insurer or pharmacy benefit manager shall furnish the data  as
     2  required  whether  the  request  is made using the drug's unique billing
     3  code, such as a National Drug Code or Healthcare Common Procedure Coding
     4  System code or descriptive term. An insurer or pharmacy benefit  manager
     5  shall not deny or unreasonably delay processing a request.
     6    (8)  An  insurer and pharmacy benefit manager shall not, except as may
     7  be required or authorized by law, interfere with, prevent, or materially
     8  discourage access, exchange, or use of the data as required;  nor  shall
     9  an  insurer  or pharmacy benefit manager penalize a health care provider
    10  for disclosing such information to an insured  or  legally  prescribing,
    11  administering,  or ordering a lower cost clinically appropriate alterna-
    12  tive.
    13    (9) Nothing in this subsection shall be construed to limit  access  to
    14  the  most  up-to-date  insured-specific  eligibility or insured-specific
    15  prescription cost and benefit data by the insurer  or  pharmacy  benefit
    16  manager.
    17    (10)  Nothing  in  this subsection shall interfere with insured choice
    18  and a health care  provider's  ability  to  convey  the  full  range  of
    19  prescription  drug  cost  options  to  an insured. Insurers and pharmacy
    20  benefit managers shall not restrict a health care provider from communi-
    21  cating to the insured prescription cost options.
    22    § 3. Section 4324 of the insurance law is  amended  by  adding  a  new
    23  subsection (g) to read as follows:
    24    (g) (1) As used in this subsection:
    25    (A)  "Pharmacy  benefit  manager"  shall have the meaning set forth in
    26  section two hundred eighty-a of the public health law.
    27    (B) "Cost-sharing  information"  means  the  amount  a  subscriber  is
    28  required to pay to receive a drug that is covered under the subscriber's
    29  insurance contract.
    30    (C)  "Covered/coverage"  means  those  health care services to which a
    31  subscriber is entitled under the terms of the insurance contract.
    32    (D) "Electronic health record" means a digital version of a  patient's
    33  paper  chart  and  medical  history  that  makes  information  available
    34  instantly and securely to authorized users.
    35    (E) "Electronic prescribing system" means a system that enables  pres-
    36  cribers  to  enter prescription information into a computer prescription
    37  device and securely transmit the  prescription  to  pharmacies  using  a
    38  special software program and connectivity to a transmission network.
    39    (F)  "Electronic  prescription"  shall  have  the meaning set forth in
    40  section thirty-three hundred two of the public health law.
    41    (G) "Prescriber" means a health care provider  licensed  to  prescribe
    42  medication or medical devices in this state.
    43    (H)   "Real-time   benefit   tool"   or  "RTBT"  means  an  electronic
    44  prescription decision support tool that: (i) is capable  of  integrating
    45  with  prescribers' electronic prescribing system and, if feasible, elec-
    46  tronic health record systems; and (ii) complies with the technical stan-
    47  dards adopted by an American National Standards Institute (ANSI) accred-
    48  ited standards development organization.
    49    (I) "Authorized third party"  shall  include  a  third  party  legally
    50  authorized  under  state  or  federal  law subject to a Health Insurance
    51  Portability and Accountability Act (HIPAA) business associate agreement.
    52    (2) The provisions of this section shall not apply to any health  plan
    53  that  exclusively  serves  individuals enrolled pursuant to a federal or
    54  state insurance affordability program, including the medical  assistance
    55  program  under  title eleven of article five of the social services law,
    56  child health plus under section twenty-five hundred eleven of the public

        A. 2200                             4
 
     1  health law, the basic health program under section three hundred  sixty-
     2  nine-gg  of  the social services law, or a plan providing services under
     3  title XVIII of the federal social security act.
     4    (3)  A  health service, hospital service, or medical expense indemnity
     5  corporation subject to this article or pharmacy benefit  manager  shall,
     6  upon  request  of the subscriber, the subscriber's health care provider,
     7  or an authorized third party on the subscriber's  behalf,  made  to  the
     8  health  service,  hospital  service, or medical expense indemnity corpo-
     9  ration or pharmacy benefit  manager,  furnish  the  cost,  benefit,  and
    10  coverage  data  required  by  this  subsection  to  the  subscriber, the
    11  subscriber's health care provider, or the  authorized  third  party  and
    12  shall  ensure  that such data is: (A) current no later than one business
    13  day after any change to the cost, benefit, or coverage data is made; (B)
    14  provided through a RTBT when the request is  made  by  the  subscriber's
    15  health  care  provider; and (C) in a format that is easily accessible to
    16  the requestor.
    17    (4) When providing the  data  required  by  paragraph  three  of  this
    18  subsection,  the  health  service,  hospital service, or medical expense
    19  indemnity corporation or pharmacy benefit manager shall use  established
    20  industry content and transport standards published by:
    21    (A)  a  standards  developing  organization accredited by the American
    22  National Standards Institute (ANSI), including, the National Council for
    23  Prescription Drug Programs (NCPDP), ASC X12, Health Level 7; or
    24    (B) a relevant federal or state governing body, including  the  Center
    25  for Medicare & Medicaid Services or the Office of the National Coordina-
    26  tor for Health Information Technology.
    27    (C)  another format deemed acceptable to the department which provides
    28  the data prescribed in paragraph three of this  subsection  and  in  the
    29  same timeliness as required by this section.
    30    (5)  A  facsimile  shall  not  be  considered an acceptable electronic
    31  format pursuant to this subsection.
    32    (6)  Upon  a  request  made  pursuant  to  paragraph  three  of   this
    33  subsection,  the  health  service,  hospital service, or medical expense
    34  indemnity corporation or pharmacy  benefit  manager  shall  provide  the
    35  following  data  for  any  drug covered under the subscriber's insurance
    36  contract:
    37    (A) subscriber-specific eligibility information;
    38    (B) subscriber-specific prescription cost and benefit  data,  such  as
    39  applicable  formulary,  benefit, coverage, and cost-sharing data for the
    40  prescribed drug and clinically-appropriate alternatives, when  appropri-
    41  ate;
    42    (C)  subscriber-specific cost-sharing information that describes vari-
    43  ance in cost-sharing based on the  pharmacy  dispensing  the  prescribed
    44  drug or its alternatives, and in relation to the insured's benefit; and
    45    (D) applicable utilization management requirements.
    46    (7)  A  health service, hospital service, or medical expense indemnity
    47  corporation or pharmacy  benefit  manager  shall  furnish  the  data  as
    48  required  whether  the  request  is made using the drug's unique billing
    49  code, such as a National Drug Code or Healthcare Common Procedure Coding
    50  System code or descriptive term. A health service, hospital service,  or
    51  medical  expense indemnity corporation or pharmacy benefit manager shall
    52  not deny or unreasonably delay processing a request.
    53    (8) A health service, hospital service, or medical  expense  indemnity
    54  corporation  and  pharmacy  benefit  manager shall not, except as may be
    55  required or authorized by law, interfere with,  prevent,  or  materially
    56  discourage access, exchange, or use of the data as required; nor shall a

        A. 2200                             5
 
     1  health  service,  hospital  service, or medical expense indemnity corpo-
     2  ration or pharmacy benefit manager penalize a health care  provider  for
     3  disclosing  such  information  to  a  subscriber or legally prescribing,
     4  administering, or ordering a lower cost, clinically appropriate alterna-
     5  tive.
     6    (9)  Nothing  in this subsection shall be construed to limit access to
     7  the most up-to-date subscriber-specific eligibility  or  subscriber-spe-
     8  cific prescription cost and benefit data by the health service, hospital
     9  service,  or  medical  expense indemnity corporation or pharmacy benefit
    10  manager.
    11    (10) Nothing in this subsection shall interfere with subscriber choice
    12  and a health care  provider's  ability  to  convey  the  full  range  of
    13  prescription drug cost options to a subscriber. Health service, hospital
    14  service,  or medical expense indemnity corporations and pharmacy benefit
    15  managers shall not restrict a health care provider from communicating to
    16  the subscriber prescription cost options.
    17    § 4. Section 4408 of the public health law is amended by adding a  new
    18  subdivision 8 to read as follows:
    19    8. (a) As used in this subdivision:
    20    (i)  "Pharmacy  benefit  manager"  shall have the meaning set forth in
    21  section two hundred eighty-a of this chapter.
    22    (ii) "Cost-sharing information"  means  the  amount  a  subscriber  is
    23  required to pay to receive a drug that is covered under the subscriber's
    24  insurance contract.
    25    (iii)  "Covered/coverage"  means those health care services to which a
    26  subscriber is entitled under the terms of the subscriber contract.
    27    (iv) "Electronic health record" means a digital version of a patient's
    28  paper  chart  and  medical  history  that  makes  information  available
    29  instantly and securely to authorized users.
    30    (v)  "Electronic prescribing system" means a system that enables pres-
    31  cribers to enter prescription information into a  computer  prescription
    32  device  and  securely  transmit  the  prescription to pharmacies using a
    33  special software program and connectivity to a transmission network.
    34    (vi) "Electronic prescription" shall have the  meaning  set  forth  in
    35  section thirty-three hundred two of this chapter.
    36    (vii)  "Prescriber" means a health care provider licensed to prescribe
    37  medication or medical devices in this state.
    38    (viii)  "Real-time  benefit  tool"  or  "RTBT"  means  an   electronic
    39  prescription  decision  support tool that: (1) is capable of integrating
    40  with prescribers' electronic prescribing system and, if feasible,  elec-
    41  tronic health record systems; and (2) complies with the technical stand-
    42  ards  adopted by an American National Standards Institute (ANSI) accred-
    43  ited standards development organization.
    44    (ix) "Authorized third party" shall  include  a  third  party  legally
    45  authorized  under  state  or  federal  law subject to a Health Insurance
    46  Portability and Accountability Act (HIPAA) business associate agreement.
    47    (b) The provisions of this section shall not apply to any health  plan
    48  that  exclusively  serves  individuals enrolled pursuant to a federal or
    49  state insurance affordability program, including the medical  assistance
    50  program  under  title eleven of article five of the social services law,
    51  child health plus under section twenty-five hundred eleven of this chap-
    52  ter, the basic health program under section three hundred  sixty-nine-gg
    53  of  the  social  services  law, or a plan providing services under title
    54  XVIII of the federal social security act.
    55    (c) A health maintenance  organization  or  pharmacy  benefit  manager
    56  shall,  upon  request  of  the  subscriber, the subscriber's health care

        A. 2200                             6
 
     1  provider, or an authorized third party on the subscriber's behalf,  made
     2  to  the  health  maintenance  organization  or pharmacy benefit manager,
     3  furnish the cost, benefit, and coverage data required by  this  subdivi-
     4  sion  to  the  subscriber, the subscriber's health care provider, or the
     5  authorized third party and shall ensure that such data is:  (i)  current
     6  no later than one business day after any change to the cost, benefit, or
     7  coverage  data is made; (ii) provided through a RTBT when the request is
     8  made by the subscriber's health care provider; and  (iii)  in  a  format
     9  that is easily accessible to the requestor.
    10    (d) When providing the data required by paragraph (c) of this subdivi-
    11  sion,  the  health  maintenance organization or pharmacy benefit manager
    12  shall use established industry content and transport standards published
    13  by:
    14    (i) a standards developing organization  accredited  by  the  American
    15  National Standards Institute (ANSI), including, the National Council for
    16  Prescription Drug Programs (NCPDP), ASC X12, Health Level 7; or
    17    (ii)  a relevant federal or state governing body, including the Center
    18  for Medicare & Medicaid Services or the Office of the National Coordina-
    19  tor for Health Information Technology.
    20    (iii)  another  format  deemed  acceptable  to  the  department  which
    21  provides the data prescribed in paragraph (c) of this subdivision and in
    22  the same timeliness as required by this section.
    23    (e)  A  facsimile  shall  not  be  considered an acceptable electronic
    24  format pursuant to this subdivision.
    25    (f) Upon a request made pursuant to paragraph (c) of this subdivision,
    26  the health maintenance organization or pharmacy  benefit  manager  shall
    27  provide  the  following data for any drug covered under the subscriber's
    28  subscriber contract:
    29    (i) subscriber-specific eligibility information;
    30    (ii) subscriber-specific prescription cost and benefit data,  such  as
    31  applicable  formulary,  benefit, coverage, and cost-sharing data for the
    32  prescribed drug and clinically-appropriate alternatives, when  appropri-
    33  ate;
    34    (iii)  subscriber-specific  cost-sharing  information  that  describes
    35  variance in cost-sharing based on the pharmacy dispensing the prescribed
    36  drug or its alternatives, and in relation to the insured's benefit; and
    37    (iv) applicable utilization management requirements.
    38    (g) A health maintenance  organization  or  pharmacy  benefit  manager
    39  shall furnish the data as required whether the request is made using the
    40  drug's  unique  billing code, such as a National Drug Code or Healthcare
    41  Common Procedure Coding System code or descriptive term. A health  main-
    42  tenance  organization  or  pharmacy  benefit  manager  shall not deny or
    43  unreasonably delay processing a request.
    44    (h) A health maintenance organization  and  pharmacy  benefit  manager
    45  shall  not,  except  as  may be required or authorized by law, interfere
    46  with, prevent, or materially discourage access, exchange, or use of  the
    47  data as required; nor shall a health maintenance organization or pharma-
    48  cy  benefit  manager penalize a health care provider for disclosing such
    49  information to a subscriber or legally  prescribing,  administering,  or
    50  ordering a lower cost, clinically appropriate alternative.
    51    (i)  Nothing in this subdivision shall be construed to limit access to
    52  the most up-to-date subscriber-specific eligibility  or  subscriber-spe-
    53  cific  prescription  cost  and  benefit  data  by the health maintenance
    54  organization or pharmacy benefit manager.
    55    (j) Nothing in this subdivision shall interfere with subscriber choice
    56  and a health care  provider's  ability  to  convey  the  full  range  of

        A. 2200                             7
 
     1  prescription  drug  cost  options  to  a  subscriber. Health maintenance
     2  organizations and pharmacy benefit managers shall not restrict a  health
     3  care  provider  from  communicating  to the subscriber prescription cost
     4  options.
     5    § 5. Severability. If any provision of this act, or any application of
     6  any  provision  of  this act, is held to be invalid, or to violate or be
     7  inconsistent with any federal law or regulation, that shall  not  affect
     8  the  validity or effectiveness of any other provision of this act, or of
     9  any other application of any provision of this act, which can  be  given
    10  effect  without  that  provision  or  application;  and to that end, the
    11  provisions and applications of this act are severable.
    12    § 6. This act shall take effect on the  same  date  and  in  the  same
    13  manner  as  a  chapter  of  the  laws of 2022 amending the insurance law
    14  relating to enacting the "patient Rx information  and  choice  expansion
    15  act",  as proposed in legislative bills numbers S. 4620-C and A. 5411-D,
    16  takes effect.
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