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A04806 Summary:

BILL NOA04806
 
SAME ASSAME AS S05436
 
SPONSORRosenthal L
 
COSPNSRJaffee, Steck, Ortiz, Weprin, Lupardo
 
MLTSPNSR
 
Add Art 28-F 2899-k, amd 2807-s, Pub Health L; amd 6507, Ed L
 
Establishes standards to advance the management and treatment of chronic pain; incorporates continuing education programs for health care professionals who treat patients that have chronic pain.
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A04806 Actions:

BILL NOA04806
 
02/03/2017referred to higher education
01/03/2018referred to higher education
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A04806 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A4806
 
SPONSOR: Rosenthal
  TITLE OF BILL: An act to amend the public health law and the educa- tion law, in relation to chronic pain management   PURPOSE: This bill improves medical education and training in chronic pain management and treatment by providing some funding support to medical school and residency training program that train physicians in this area of medicine. It also establishes the State Chronic Pain Management Education and Training Council to advise the commissioners of Health and Education on establishing standards to advance the management and treat- ment of chronic pain and to suggest course materials that should be incorporated in continuing education programs for the many health care professionals that treat patients that have chronic pain.   SUMMARY OF SPECIFIC PROVISIONS: Section one states the legislative intent. Section two creates a new Article 28-F in the public health law, which: *Provides grants for medical school education in chronic pain care treatment and management that may be used for faculty development and recruitment, and teaching at hospital based ambulatory care settings and hospices, including personnel, administration, and student-related expenses. Grants awarded through a competitive application process are to be monitored by the newly created state Chronic Pain Management Education and Training Council. * Provides grants for residency medical education in chronic pain care treatment and management that may be used for faculty development and recruitment, start-up costs and teaching at hospital based chronic pain care settings and non-hospital based care sites, including personnel, administration and trainee related costs. Grants are to be awarded through a competitive application process monitored by the Council. *Authorizes the commissioner of Health to designate Chronic Pain Health Care professional practitioner Resource Centers which may be state-wide or regional, to provide technical information and guidance for practi- tioners on the treatment and management of chronic pain. Such treatment and management can include new and advanced strategies, therapies and medications in this area of medicine. The resource centers must be not- for-profit but they may charge fees to defray the cost of the service. *Establishes a New York State Chronic Pain Management Education and Training Council by outlining the membership of this new council and its duties on advising the Commissioner of Health on encouraging medical schools and graduate medical educators to better highlight the need to treat and manage chronic pain. Further, to help develop better models of interdisciplinary cooperation between different health care profes- sionals who treat individuals that have chronic pain. Doing this may be able to help increase the coordination of care, and thereby benefit a patient's well-being and simultaneously help to reduce health care costs by reducing the number of patient visits, diagnostic tests conducted, and strong pain medications administered. * Outlines public policies that should be considered, examined and possibly advanced by the Council. * Authorizes the Council to make suggestions to the Departments of Health and Education on how to better present course materials to health care professionals in continuing education programs that educate such professionals in the management and treatment of chronic pain. Section three amends section 6507 (3) of the education law to grant to the Education Department the ability to accept the recommendations of the Council in revising the continuing education requirements of certain health care professionals that are licensed pursuant to the Education Law. Such recommendations and alterations in the provision of such continuing education shall be tailored to the specific health care profession in question. Section four allocates up to $2.5 million in Health Care Reform Act (HCRA) funds for grants for medical school education in chronic pain care and up to $2.5 million in Health Care Reform Act (HCRA) funds for grants for graduate medical education in palliative care. Section five sets forth the effective date.   JUSTIFICATION: Improving the management and treatment of chronic pain in New York, especially the treatment of chronic pain, that leads to a patient's decrease in physical activity, increased obesity rates, higher rates of unemployment and higher rates of mental anguish are important medical and patient wellbeing goals. Research in New York and nationally has documented that there may be a general lack of knowledge among many segments of health care practitioner community concerning chronic pain care and the diagnosis and treatment of such pain. New York, being one of the centers for medical school education and education for other health care professionals in the country, should consider expanding education for physicians and others in chronic care. The Council created by this bill should provide a focal point for those interested in the treatment and management of chronic pain both as an area of separate study and as an area for further advances in interdis- ciplinary study among the various treating professions. Further the bill helps to provide technical support for practicing physicians and other health care professionals who are faced with complex or unfamiliar pain-related conditions. To develop these resources, experts in chronic pain care management from New York's medical community should be engaged in the process, thus ensuring that vital clinical and educational expertise is available. Developing residency programs for physicians and other health care professionals will improve the training of new health care profes- sionals. Further, it will generally improve the awareness and quality of chronic pain care among all health care professionals who practice at the residency program sites.   LEGISLATIVE HISTORY: 2015-16: A.1671 - Referred to Higher Education 2013-14: A.9250 - Referred to Higher Education; S.2361-A - Referred to Health   FISCAL IMPLICATIONS: The bill authorizes the allocation of up to $5 million in existing HCPA funds, upon the appropriation of such funds and the Commissioner of Health authorizing the disbursement of such funds.   EFFECTIVE DATE: This bill shall take effect immediately.
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A04806 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          4806
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 3, 2017
                                       ___________
 
        Introduced  by  M.  of A. ROSENTHAL, JAFFEE -- read once and referred to
          the Committee on Higher Education
 
        AN ACT to amend the public health law and the education law, in relation
          to chronic pain management
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Legislative  intent:  The  legislature  hereby finds that
     2  medical treatment of chronic pain in this state needs to  be  reexamined
     3  to  enhance  the  ability  to  assess such condition, increase access to
     4  appropriate care to treat and mitigate chronic  pain,  and  improve  the
     5  quality  of  life  for  those  afflicted  with this condition. Currently
     6  chronic pain is most often treated by primary  care  providers  who  may
     7  have  little  training in the assessment and proper treatment of complex
     8  chronic pain conditions. This, in turn,  has  led,  in  certain  circum-
     9  stances,  to  patients seeing multiple health care providers and experi-
    10  encing multiple and repeated diagnostic tests, that lead  to  inadequate
    11  or  unproven  surgeries, prescription of unneeded or strong pain medica-
    12  tions, with its consequential heightened possibility to lead to the long
    13  term addiction to such strong pain medications, and the  performance  of
    14  procedures or treatment regimens that are not able to successfully treat
    15  or mitigate such chronic pain.
    16    Further, the current practice of the repeated utilization of different
    17  health  practitioners, tests and unnecessary medical procedures to treat
    18  such chronic pain is resulting in  higher  health  care  costs.    These
    19  increased  costs come from unnecessary visits to health care practition-
    20  ers, more and longer hospital stays, performing unnecessary surgeries or
    21  other medical procedures, and unnecessary  prescription  of  costly  and
    22  dangerous  drugs. This inefficient use of valuable health care resources
    23  is contributing to the rapidly increasing cost of providing health care.
    24  With the continuing aging of New York's general population,  this  trend
    25  may  only  continue  to  grow.  Further,  the  consequences  to patients
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05455-01-7

        A. 4806                             2
 
     1  afflicted with chronic pain will continue  to  undermine  the  physical,
     2  social,  economic  and  psychological well being of such patients, their
     3  families and loved ones.
     4    The  current  health  care delivery system both over treats and under-
     5  treats those afflicted with chronic pain. Ideally, all patients  subject
     6  to  chronic  pain  should be able to obtain an appropriate assessment of
     7  the underlying conditions that cause such pain, followed by an appropri-
     8  ate plan of care that reflects the best practices currently available to
     9  prevent the adverse effects of pain. Such care should be provided  in  a
    10  coordinated  manner  that minimizes such chronic pain and is cost effec-
    11  tive for the patient, health care delivery system, and for employers  of
    12  such  persons.  In sum, the provision of chronic pain treatments needs a
    13  major reassessment to enhance assessment capabilities,  increase  access
    14  to  appropriate care, improve the quality of care, and do so in a manner
    15  that minimizes the cost of providing such care.
    16    § 2. The public health law is amended by adding a new article 28-F  to
    17  read as follows:
    18                                ARTICLE 28-F
    19                           CHRONIC PAIN MANAGEMENT
    20  Section 2899-k. Chronic pain management.
    21    § 2899-k. Chronic pain management. 1. Definitions. The following words
    22  or phrases as used in this article shall have the following meanings:
    23    (a) "chronic pain" shall mean consistent and significant physical pain
    24  or  discomfort that lasts for an extended period of time beyond an acute
    25  physical injury or painful stimulus, and persists unabated for a  period
    26  of  time  greater  than  six  months. Further such condition impedes the
    27  ability of such person from conducting many normal life  activities,  or
    28  impedes  or  leads to the loss of employment, or curtails the ability to
    29  perform a number of previously executed physical employment tasks.  Such
    30  chronic  pain  may  be associated with cancer pain, pain from chronic or
    31  degenerative diseases or conditions, or from an unidentified cause.
    32    (b) "chronic pain care certified medical school" shall mean a  medical
    33  school  in  the  state  which is an institution which grants a degree of
    34  doctor of medicine or doctor of osteopathic medicine in accordance  with
    35  regulations  promulgated  by  the  commissioner of education pursuant to
    36  subdivision two of section sixty-five hundred twenty-four of the  educa-
    37  tion  law,  and  which meets the standards established pursuant to regu-
    38  lations promulgated by the commissioner,  after  consultation  with  the
    39  council, that are used to determine whether a medical school is eligible
    40  for funding pursuant to this section.
    41    (c) "chronic pain care certified residency program" shall mean a grad-
    42  uate  medical education program in the state which has received accredi-
    43  tation from a nationally recognized accreditation body  for  medical  or
    44  osteopathic  residency  programs,  and  which meets the standards estab-
    45  lished pursuant to regulations promulgated by  the  commissioner,  after
    46  consultation  with  the  council,  that  are used to determine whether a
    47  residency training program is eligible  for  funding  pursuant  to  this
    48  section.
    49    (d)  "council"  shall mean the state chronic pain management education
    50  and training council established by subdivision two of this section.
    51    (e) "health care professionals" shall mean and  include  those  health
    52  care  professionals who regularly treat patients that have chronic pain,
    53  and includes, but is  not  limited  to,  acupuncturists,  chiropractors,
    54  dentists,  nurse  practitioners,  registered professional nurses, podia-
    55  trists, pharmacists, physicians, physical therapists, physician  assist-
    56  ants, psychiatrists and occupational therapists.

        A. 4806                             3
 
     1    (f)  "professional  continuing  education"  or  "continuing education"
     2  shall mean  all  professional  continuing  education  programs  required
     3  either  by  state  law or by professional associations authorized by the
     4  education department to monitor the requirements of  licensure,  and  to
     5  conduct and approve professional continuing education requirements for a
     6  health  care  profession.    Such  professions shall include, but not be
     7  limited to, acupuncture,  chiropractic,  dentistry,  nursing,  podiatry,
     8  pharmacy,  medicine,  physical therapy, physician assistance, psychology
     9  and occupational therapy.
    10    2. State chronic pain management education and training council.   (a)
    11  The  state  chronic  pain  management  education and training council is
    12  hereby established in the department to be an expert panel to advise the
    13  commissioner and commissioner of education on: (i) advances in the opti-
    14  mum treatment, management and best practices related  to  mitigating  or
    15  alleviating  chronic  pain, (ii) to promote better interdisciplinary and
    16  coordinated provision of care related to chronic pain management,  (iii)
    17  to develop new public policies related to advancing the teaching of such
    18  new  treatments,  management regimens, or best practices on chronic pain
    19  management and care in chronic pain care certified medical  schools  and
    20  chronic  pain care certified residency programs, and (iv) develop guide-
    21  lines to assist the education department in establishing  materials  and
    22  curricula  to  be  used  in  providing professional continuing education
    23  programs for those health care professionals regulated by  such  depart-
    24  ment.
    25    (b)  The council shall be composed of twenty-five members appointed by
    26  the  commissioner.  The  commissioner  shall  seek  recommendations  for
    27  appointments  to  such  council from health care professional, consumer,
    28  medical institutional, medical educational  leaders  and  other  profes-
    29  sional  educational leaders from this state. The membership of the coun-
    30  cil shall include: nine representatives of medical schools and  hospital
    31  organizations;  two representatives of medical academies; one acupunctu-
    32  rist licensed pursuant to section eighty-two  hundred  fourteen  of  the
    33  education  law;  individual  representatives  of  organizations  broadly
    34  representative of physicians, family  physicians,  primary  care  physi-
    35  cians,  internal  medicine, rheumatology, nursing, gerontology, hospice,
    36  neurology, psychiatry, pediatrics,  surgery,  acupuncture,  chiropractic
    37  care,  podiatric care, pharmacists or those professionals related to the
    38  prescription or manufacture of pain medications, emergency  room  health
    39  care professionals, massage therapists, occupational and physical thera-
    40  py,  patient  advocates and the hospital philanthropic community; health
    41  care plan payors or insurers; the executive director or a member of  the
    42  New  York  state  council on graduate medical education; and a member of
    43  the New York state palliative care education and training council.
    44    (c) The members of the council shall have expertise in  the  treatment
    45  and  management  of  chronic  pain  and  the  care  of patients that are
    46  afflicted with chronic pain conditions. The term of such  members  shall
    47  be  four  years  and such terms may be renewed. Members shall receive no
    48  compensation for their services, but shall be allowed actual and  neces-
    49  sary expenses in the performance of their duties.
    50    (d) A chair and vice-chair of the council shall be elected annually by
    51  the council. The council shall meet upon the call of the commissioner or
    52  the  chair.  The  council  may  adopt  regulations  consistent with this
    53  section.
    54    (e) The commissioner shall designate such employees  and  provide  for
    55  other  resources  from  the department as may be reasonably necessary to
    56  provide support and services for the work of the  council.  The  council

        A. 4806                             4

     1  may  employ additional staff and consultants and incur other expenses to
     2  carry out its duties, to be paid for from  amounts  which  may  be  made
     3  available to the council for that purpose.
     4    (f)  The  council  may  provide  technical information and guidance to
     5  health care professionals on  the  latest  best  practices,  strategies,
     6  therapies  and  medications to treat or manage chronic pain. Further, to
     7  provide technical information and guidance to health care  professionals
     8  to  encourage  better  coordinated  care  to  treat or mitigate the pain
     9  suffered by chronic pain patients.
    10    3.  Policies to be considered, examined and possibly advanced  by  the
    11  council.  The  council shall consider and examine the following policies
    12  and guidelines in the adoption of any rules and regulations:
    13    (a) The treatment and care provided to patients  that  suffer  chronic
    14  pain should be centered in the primary care environment and foster coor-
    15  dinated care between the various health care professional disciplines.
    16    (b)  Chronic  pain  management  and care should be coordinated to help
    17  minimize the dispensing of prescription  drugs,  avoid  duplicative  and
    18  costly  evaluations  and  diagnostic  tests,  and treatments to minimize
    19  chronic pain.
    20    (c) Development of chronic pain management and  care  techniques  that
    21  address  discrepancies that may occur in the treatment of patients based
    22  on race, ethnicity, gender, income level or age.
    23    (d) Develop and promote the use of  best  practices  to  mitigate  the
    24  suffering  of  chronic  pain  in  patients. The utilization of such best
    25  practices can be promoted by: (i) the provision of professional continu-
    26  ing education programs to all health care professionals on  advances  in
    27  best  practices in chronic pain management and care, and (ii) the devel-
    28  opment of advances in best practices based  on  new  research,  clinical
    29  experience,  and  the promotion of inter-disciplinary dialog and cooper-
    30  ation between the various health care professionals.
    31    (e) Encourage the wider use of coordinated health information technol-
    32  ogy systems to track pain disorders, treatments, and outcomes as a mech-
    33  anism to improve chronic pain care and to better  integrate  coordinated
    34  care among the various treating health care professionals.
    35    (f)  Consider  alterations in Medicaid and private payor reimbursement
    36  rates and practices to  encourage  more  optimum  provision  of  quality
    37  chronic pain management and care by all health care professionals.
    38    (g)  Encourage  a balanced approach to regulate the distribution, use,
    39  and prescription of medications that are  used  to  treat  chronic  pain
    40  conditions.  Such  balanced  approach  needs to ensure that patients can
    41  obtain the medications that they need, but are not over prescribed  such
    42  medications,  which  can  lead  to patient abuse or long term addiction.
    43  Further, the need to  monitor  multiple  daily  medication  prescription
    44  regimens,  coupled  with  psychological,  behavioral,  and social inter-
    45  vention activities of such patients. Further, to reduce  the  threat  of
    46  drug  abuse,  addiction  or  diversion  of  such medications to uses not
    47  related to proper treatment of chronic pain conditions.
    48    4. Grants for undergraduate medical education in chronic  pain  treat-
    49  ment  and management. (a) The commissioner is authorized, within amounts
    50  from any source appropriated or otherwise provided for such purpose,  to
    51  make  grants  to chronic pain care certified medical schools and schools
    52  of health care professionals to enhance the study and research of chron-
    53  ic pain treatment and management, increase the opportunities for  under-
    54  graduate  medical  education  in chronic pain care treatment and manage-
    55  ment, and encourage the education of physicians  in  chronic  pain  care
    56  management and treatment.

        A. 4806                             5
 
     1    (b)  Grant  proceeds  under  this  subdivision may be used for faculty
     2  development in chronic pain care treatment and  management;  recruitment
     3  of  faculty with an expertise in the management and treatment of chronic
     4  pain; costs incurred teaching medical students at hospital-based  sites,
     5  non-hospital based ambulatory care settings, certified home health agen-
     6  cies,  licensed  long term home health care programs, private and public
     7  health care clinics, and in private physician practices  including,  but
     8  not  limited  to personnel, administration and student-related expenses;
     9  expansion or development of programs that train physicians in the treat-
    10  ment and management of  chronic  pain;  and  other  innovative  programs
    11  designed  to  increase  the  competency  of  medical students to provide
    12  chronic pain care to patients.
    13    (c) Grants under this subdivision shall be awarded by the commissioner
    14  through a competitive application process to the  council.  The  council
    15  shall make recommendations for funding to the commissioner.
    16    5.  Grants  for graduate health care professional education in chronic
    17  pain treatment and management. (a) The commissioner is authorized, with-
    18  in amounts from any source appropriated or otherwise provided  for  such
    19  purpose,  to  make  grants  to  chronic  pain  care  certified residency
    20  programs to establish or expand education in chronic pain treatment  and
    21  management  for graduate medical education, and to increase the opportu-
    22  nities for trainee education in the treatment and management of  chronic
    23  pain in the hospital-based and non-hospital-based settings.
    24    (b)  Grants  under  this  subdivision for graduate health care profes-
    25  sional education and education in chronic pain treatment and  management
    26  may  be  used  for  administration, faculty recruitment and development;
    27  start-up costs and costs incurred teaching the most advanced strategies,
    28  therapies, medications or best practices with  regard  to  the  care  of
    29  patients  with  chronic  pain  in  either hospital-based or non-hospital
    30  based settings including, but not limited to  personnel,  administration
    31  and  trainee  related expenses; and other expenses deemed reasonable and
    32  necessary by the commissioner.
    33    (c) Grants under this subdivision shall be awarded by the commissioner
    34  through a competitive application process to the  council.  The  council
    35  shall make recommendations for funding to the commissioner.
    36    6.   Chronic  pain  health  care  professional  practitioner  resource
    37  centers.  The commissioner, in consultation with the council, may desig-
    38  nate a chronic  pain  treatment  and  management  practitioner  resource
    39  center  or  centers.  Such resource center may be statewide or regional,
    40  and shall act as a source of technical support, information and guidance
    41  for practitioners on the latest strategies,  therapies,  medications  or
    42  best  practices  with  regard to the optimum treatment and management of
    43  chronic pain. The department, in  consultation  with  the  council,  may
    44  contract  with not-for-profit organizations or associations to establish
    45  and manage such resource centers. Such resource centers may charge a fee
    46  to help offset the cost of providing such services.
    47    7. Continuing education requirements for  health  care  professionals.
    48  The  council, in consultation with the department, the education depart-
    49  ment and health care professional organizations, shall develop,  compile
    50  and  publish  information and course materials on the advanced treatment
    51  and mitigation of chronic pain suffered by patients. In addition  within
    52  two  years of the effective date of this article, the council shall make
    53  recommendations to the education department for the course work,  train-
    54  ing  and  curriculum  to  be included in the continuing education on the
    55  best practices, strategies, therapies and approaches for the  mitigation
    56  and  treatment  of  chronic pain required to be completed by the various

        A. 4806                             6
 
     1  health care professions pursuant to paragraph d of subdivision three  of
     2  section  sixty-five hundred seven of the education law. Such recommenda-
     3  tions shall include components which address the increasing  and  neces-
     4  sary interdisciplinary cooperation between health care professionals for
     5  the  coordinated reduction of chronic pain in patients and the reduction
     6  of health care costs.
     7    8. Report.  On or before March first of each odd  numbered  year,  the
     8  council shall submit to the governor, the commissioner, the commissioner
     9  of  education, the temporary president of the senate, the speaker of the
    10  assembly, and the chairs of the senate and assembly committees on health
    11  a report on its activities and accomplishments relating to the treatment
    12  and mitigation of chronic pain. Such report may also include such legis-
    13  lative proposals as it deems necessary to more effectively implement the
    14  provisions of this article.
    15    § 3. Paragraphs b and c of subdivision 3 of section 6507 of the educa-
    16  tion law, as added by chapter 987 of the laws of 1971, are amended and a
    17  new paragraph d is added to read as follows:
    18    b. Review qualifications in connection  with  licensing  requirements;
    19  [and]
    20    c. Provide for licensing examinations and reexaminations[.]; and
    21    d. (i) Establish standards for preprofessional and professional educa-
    22  tion  for  health  care  professionals,  as  defined in paragraph (e) of
    23  subdivision one of section twenty-eight  hundred  ninety-nine-k  of  the
    24  public  health  law, relating to the mitigation and treatment of chronic
    25  pain. In the promulgation of such  standards,  the  department  and  the
    26  appropriate  board  of  each  such profession shall consider and, to the
    27  extent practicable, implement the recommendations of the  state  chronic
    28  pain management education and training council. Furthermore, such stand-
    29  ards  shall  provide  for  such  training and coursework on the advanced
    30  treatment and mitigation of chronic pain as shall be appropriate for the
    31  health care profession, and shall address the increasing  and  necessary
    32  interdisciplinary  cooperation between health care professionals for the
    33  coordinated reduction of chronic pain in patients and the  reduction  of
    34  health care costs.
    35    (ii)  The  commissioner  shall  establish standards requiring that all
    36  health care professionals applying, on or after January first, two thou-
    37  sand twenty, initially or for a renewal of a  license,  registration  or
    38  certificate  pursuant  to  this  title,  shall, in addition to all other
    39  licensure, registration or certification  requirements,  have  completed
    40  such  coursework and training in the treatment and mitigation of chronic
    41  pain as shall be required pursuant to subparagraph  (i)  of  this  para-
    42  graph. The coursework and training shall be obtained from an institution
    43  or  provider  that  has  been approved by the department to provide such
    44  coursework and training. Each applicant  shall  provide  the  department
    45  with  documentation  showing he or she has completed the required train-
    46  ing.
    47    (iii) The department shall provide an exemption from the  requirements
    48  of  subparagraphs  (i)  and  (ii)  of  this paragraph to any health care
    49  professional who requests such an exemption and who demonstrates to  the
    50  department's satisfaction that:
    51    (A)  there would be no need for him or her to complete such coursework
    52  and training because of the nature of his or her practice; or
    53    (B) he or she has completed coursework  and  training  deemed  by  the
    54  department to be equivalent to the standards for coursework and training
    55  approved by the department under this paragraph.

        A. 4806                             7
 
     1    §  4.  Subdivision  7  of  section  2807-s of the public health law is
     2  amended by adding a new paragraph (d) to read as follows:
     3    (d)  notwithstanding any inconsistent provision of this section, prior
     4  to the allocation of funds for distribution in accordance  with  section
     5  twenty-eight  hundred seven-j of this article pursuant to paragraphs (b)
     6  and (c) of this subdivision, the commissioner on an annualized basis  up
     7  to  two million five hundred thousand dollars for grants for undergradu-
     8  ate health care professional education in  chronic  pain  treatment  and
     9  management  pursuant to subdivision four of section twenty-eight hundred
    10  ninety-nine-k of this chapter; and up to two million five hundred  thou-
    11  sand  dollars for grants for graduate health care professional education
    12  in chronic pain treatment and management pursuant to subdivision five of
    13  section twenty-eight hundred ninety-nine-k of this chapter.
    14    § 5. This act shall take effect immediately provided that  the  amend-
    15  ments  to  subdivision 7 of section 2807-s of the public health law made
    16  by section four of this act shall not  affect  the  expiration  of  such
    17  section and shall expire therewith.
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