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S03460 Summary:

BILL NOS03460
 
SAME ASSAME AS A04416
 
SPONSORRIVERA
 
COSPNSRHOYLMAN, KRUEGER, MAY, MONTGOMERY, PERSAUD
 
MLTSPNSR
 
Amd 460-d, 461-c, 461-d, 461-e & 461-a, Soc Serv L; amd 29.15, Ment Hyg L
 
Relates to violations of safety conditions in adult care facilities; provides penalties for safety violations and operating without a valid license; prohibits reductions in fines in certain circumstances where a patient is endangered or harmed.
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S03460 Actions:

BILL NOS03460
 
02/07/2019REFERRED TO SOCIAL SERVICES
03/01/2019COMMITTEE DISCHARGED AND COMMITTED TO HEALTH
05/07/20191ST REPORT CAL.620
05/08/20192ND REPORT CAL.
05/13/2019ADVANCED TO THIRD READING
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S03460 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3460
 
                               2019-2020 Regular Sessions
 
                    IN SENATE
 
                                    February 7, 2019
                                       ___________
 
        Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
          printed to be committed to the Committee on Social Services
 
        AN ACT to amend the social services law and the mental hygiene  law,  in
          relation to violations of safety conditions in adult care facilities
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1.  Paragraph (b) of subdivision 4 of  section  460-d  of  the
     2  social  services  law, as amended by chapter 733 of the laws of 1994, is
     3  amended to read as follows:
     4    (b) No operating certificate shall be revoked,  suspended  or  limited
     5  without  a  hearing  held  in  accordance with procedures established by
     6  department regulations, which procedures shall require  that  notice  of
     7  the  time  and place of the hearing, and notice of the charges, shall be
     8  served in person or by certified mail addressed to the facility at least
     9  thirty days prior to the date of the hearing. A written  answer  to  the
    10  charges may be filed with the department not less than ten business days
    11  prior  to  the date of the hearing. An operating certificate may, never-
    12  theless, be suspended or limited without a hearing for a period  not  in
    13  excess  of  sixty  days, upon written notice to the facility following a
    14  finding by the department that the public  health,  or  an  individual's
    15  health,  safety  or  welfare, are in imminent danger; provided, however,
    16  that if the department makes reasonable efforts to  commence  a  hearing
    17  within  such  sixty  day  period  and  to complete such hearing within a
    18  reasonable period of time, the hearing officer may authorize the depart-
    19  ment to extend the period of suspension or limitation for an appropriate
    20  period of time, but in no event beyond the  date  when  the  hearing  is
    21  completed and available administrative appeals are exhausted.
    22    §  2.  Subdivision  7  of section 460-d of the social services law, as
    23  added by chapter 669 of the laws of 1977, paragraph (a)  as  amended  by
    24  chapter 719 of the laws of 1989, paragraph (b) as amended by chapter 524
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04051-03-9

        S. 3460                             2
 
     1  of the laws of 1984, subparagraph 2 of paragraph (b) as amended by chap-
     2  ter 733 of the laws of 1994, is amended to read as follows:
     3    7.  (a)  The  department  shall  adopt  regulations establishing civil
     4  penalties of up to [one] five thousand dollars per day per violation  to
     5  be assessed against all adult care facilities except facilities operated
     6  by  a  social services district for violations of (i) regulations of the
     7  department pertaining to the care of residents in such facilities,  (ii)
     8  paragraph  (a)  of subdivision three of section four hundred sixty-one-a
     9  of this [chapter] article, or (iii) an order issued pursuant to subdivi-
    10  sion eight of this section. The regulations shall specify the violations
    11  subject to penalty and the amount of  the  penalty  to  be  assessed  in
    12  connection  with  each  such violation and shall specify that only civil
    13  penalties of up to [one] five thousand dollars  per  day  per  violation
    14  shall  be  assessed  pursuant  to  this  paragraph against an adult care
    15  facility found responsible for an act of retaliation or reprisal against
    16  any resident, employee, or other person for  having  filed  a  complaint
    17  with  or  having  provided  information  to any long term care [patient]
    18  ombudsman functioning in accordance with section  [five  hundred  forty-
    19  four or five hundred forty-five] two hundred eighteen of the [executive]
    20  elder law.
    21    (b)  [(1)] In addition to any other civil or criminal penalty provided
    22  by law, the department shall have the power to assess civil penalties in
    23  accordance with its regulations adopted pursuant  to  paragraph  (a)  of
    24  this  subdivision,  after  a  hearing  conducted  in accordance with the
    25  procedures established by regulations of the department. Such procedures
    26  shall require that notice of the time and place of the hearing, together
    27  with a statement of charges of violations, shall be served in person  or
    28  by  certified  mail addressed to the facility at least thirty days prior
    29  to the date of the hearing. The statement of charges of violations shall
    30  set forth the existence of the violations, the  amount  of  penalty  for
    31  which  it may become liable and the steps which must be taken to rectify
    32  the violation and, where applicable, a  statement  that  the  department
    33  contends  that  a penalty may be imposed under this paragraph regardless
    34  of rectification. An answer to the charges of  violations,  in  writing,
    35  shall  be filed with the department, not less than ten days prior to the
    36  date of hearing. The answer shall notify the department of  the  facili-
    37  ty's  position with respect to each of the charges and shall include all
    38  matters which if not disclosed in the answer would be likely to take the
    39  department by surprise. The commissioner, or a member of his  staff  who
    40  is  designated  and  authorized  by him to hold such hearing, may in his
    41  discretion allow the facility to prove any matter not  included  in  the
    42  answer.
    43    (c)  (1) Where the facility satisfactorily demonstrates that it either
    44  had rectified the violations within thirty  days  of  receiving  written
    45  notification  of  the results of the inspection pursuant to section four
    46  hundred sixty-one-a of this [chapter] article, or had  submitted  within
    47  [thirty]  fourteen  days  an  acceptable  plan for rectification and was
    48  rectifying the violations in accordance with the steps  and  within  the
    49  additional  periods  of time as accepted by the department in such plan,
    50  [no] the department may determine that the penalty  under  this  section
    51  shall be reduced from what otherwise would be imposed, or waived, except
    52  as  provided  in  subparagraph two of this paragraph , and only after it
    53  finds particular circumstances justifying a reduction or waiver  of  the
    54  fine, considering:
    55    (i) the cause of the violation being an isolated incident and not part
    56  of a pattern or practice;

        S. 3460                             3
 
     1    (ii) the number of residents affected by the violation;
     2    (iii) the risk of harm or endangerment created by the violation;
     3    (iv) the facility's history of citations and violations;
     4    (v)  the  promptness  of rectification, if delay was occasioned by the
     5  department; and
     6    (vi) the specific circumstances of the violations.
     7    (2) [Rectification shall not preclude the assessment of a  penalty  if
     8  the  department  establishes  at  a hearing that a particular violation,
     9  although corrected, endangered or resulted in harm to  any  resident  as
    10  the result of:
    11    (i)] No fine shall be reduced or waived for a violation that:
    12    (i) endangered any resident.  Endangerment is defined as:
    13    (A)  the total or substantial failure of the facility's fire detection
    14  or prevention systems, or emergency evacuation procedures prescribed  by
    15  department safety standard regulations;
    16    [(ii)] (B) the retention of any resident who has been evaluated by the
    17  resident's physician as being medically or mentally unsuited for care in
    18  the  facility  or  as  requiring  placement in a hospital or residential
    19  health care facility and for whom the operator is not making  persistent
    20  efforts to secure appropriate placement;
    21    [(iii)] (C) the failure in systemic practices and procedures;
    22    [(iv)]  (D) the failure of the operator to take actions as required by
    23  department regulations in the event of a resident's illness or accident;
    24    [(v)] (E) the failure of the operator to provide at all  times  super-
    25  vision of residents by numbers of staff at least equivalent to the night
    26  staffing requirement set forth in department regulations; or
    27    [(vi)]  (F)  unreasonable  threats of retaliation or taking reprisals,
    28  including but not limited to unreasonable threats of eviction or  hospi-
    29  talization  against  any  resident, employee or other person who makes a
    30  complaint concerning the operation of an adult  care  facility,  partic-
    31  ipates  in  the  investigation  of  a  complaint or is the subject of an
    32  action identified in a complaint[.
    33    The department shall specify in its regulations those  regulations  to
    34  which this subparagraph two shall apply.
    35    (3)  In assessing penalties pursuant to this paragraph, the department
    36  shall consider promptness of  rectification,  delay  occasioned  by  the
    37  department, and the specific circumstances of the violations as mitigat-
    38  ing factors.
    39    (c)];
    40    (ii) resulted in harm to any resident, including but not limited to:
    41    (A) physical injury;
    42    (B) loss or denial of access to money or other personal property; or
    43    (C)  being  the  object  of words or conduct that constitute bullying,
    44  harassment, humiliation, infantilization, intimidation, taunt, ridicule,
    45  a threat, or derogatory comment; or
    46    (iii) is  a  repeat  violation.  Repeat  violation  is  defined  as  a
    47  violation for which the facility was cited by the department at any time
    48  in the previous twelve months.
    49    (d)  Upon  the  request  of  the  department, the attorney general may
    50  commence an action in any court of competent  jurisdiction  against  any
    51  facility  subject  to  the  provisions  of this section, and against any
    52  person or corporation operating such facility, for the recovery  of  any
    53  penalty  assessed by the department in accordance with the provisions of
    54  this subdivision.
    55    [(d)] (e) Any such penalty assessed by the department may be  released
    56  or  compromised  by the department, subject to and consistent with para-

        S. 3460                             4
 
     1  graph (c) of this subdivision, before the matter has  been  referred  to
     2  the  attorney  general,  and  where such matter has been referred to the
     3  attorney general, any such penalty may be released  or  compromised  and
     4  any action commenced to recover the same may be settled and discontinued
     5  by  the attorney general, after considering paragraph (c) of this subdi-
     6  vision and with the consent of the department.
     7    § 3. Paragraphs (a) and (b) of subdivision 9 of section 460-d  of  the
     8  social services law, paragraph (a) as amended by chapter 558 of the laws
     9  of  1999  and paragraph (b) as added by chapter 848 of the laws of 1992,
    10  are amended to read as follows:
    11    (a) The department shall have authority to impose a civil penalty [not
    12  exceeding one thousand dollars per day] consistent with  section  twelve
    13  of  the  public  health law against, and to issue an order requiring the
    14  closing of, after notice and opportunity to be heard, any facility which
    15  does not possess a valid operating certificate issued by the  department
    16  and  is an adult care facility subject to the provisions of this article
    17  and the regulations of the department. A hearing shall be  conducted  in
    18  accordance  with  procedures established by department regulations which
    19  procedures shall require that  notice  of  the  determination  that  the
    20  facility  is  an  adult  care facility and the reasons for such determi-
    21  nation and notice of the time and place of  the  hearing  be  served  in
    22  person  on  the operator, owner or prime lessor, if any, or by certified
    23  mail, return receipt requested, addressed to such person and received at
    24  least twenty days prior to the date of the hearing.  If  such  operator,
    25  owner  or  prime  lessor,  if  any, is not known to the department, then
    26  service may be made by posting a copy thereof  in  a  conspicuous  place
    27  within  the  facility  or  by  sending a copy thereof by certified mail,
    28  return receipt requested, addressed to the facility. A written answer to
    29  the notice of violation may be filed with the department not  less  than
    30  five days prior to the date of the hearing.  Demonstration by the facil-
    31  ity  that  it possessed an operating certificate issued pursuant to this
    32  article, article twenty-eight  of  the  public  health  law  or  article
    33  sixteen,  [twenty-three,] thirty-one or thirty-two of the mental hygiene
    34  law at the time the hearing was commenced shall  constitute  a  complete
    35  defense to any charges made pursuant to this subdivision.
    36    (b)  [The penalty authorized by this section shall begin to run thirty
    37  days after the department provides the  operator,  in  writing,  with  a
    38  summary of the inspection of the facility by which the department deter-
    39  mined  that  he or she is operating an uncertified adult care facility.]
    40  The submission of an  application  by  the  operator  for  an  operating
    41  certificate for the facility shall not act as a bar to the imposition of
    42  a penalty against the operator of an unlicensed adult care facility.
    43    §  4.  Paragraph  (c)  of subdivision 9 of section 460-d of the social
    44  services law is amended by adding a new subparagraph  (iv)  to  read  as
    45  follows:
    46    (iv)  If  the department of health determines, based on a complaint or
    47  other facts known to the department, that there  is  reason  to  believe
    48  that  an individual or entity is operating an adult home, enriched hous-
    49  ing program, or residence for adults which  does  not  possess  a  valid
    50  operating  certificate  issued  by  the department, and that one or more
    51  conditions or activities at such facility constitute or  are  likely  to
    52  give  rise  to  an  immediate danger to the health of the residents, and
    53  awaiting a court order pursuant to subparagraph (iii) of this  paragraph
    54  would  be  seriously  detrimental  to  the health of such residents, the
    55  department of health may, notwithstanding an objection by the  operator,
    56  administrator  or  other  person in charge, inspect the entire premises,

        S. 3460                             5
 
     1  which shall include access to all dwellings on the said  property  which
     2  house tenants/occupants as well as access to such tenants/occupants, for
     3  the  purpose  of ascertaining whether such danger exists or is likely to
     4  arise  on  an  immediate basis. The department of health may request the
     5  assistance of local law enforcement for purposes of  carrying  out  such
     6  inspection  and  may  take  any appropriate action if it determines that
     7  such danger exists or is likely to arise, including  issuing  a  written
     8  notice  directing  the operator, administrator or other person in charge
     9  of such facility to cease or correct the condition or activity at issue.
    10  As promptly as possible  thereafter,  within  a  period  not  to  exceed
    11  fifteen days, the commissioner shall provide the operator an opportunity
    12  to  be  heard  and  to present any proof that such condition or activity
    13  does not constitute a danger to the health  of  the  residents  of  such
    14  facility.  The  attorney  general,  upon  request  of  the department of
    15  health, shall be authorized to apply to the supreme court in the  county
    16  in  which the facility is located for an order for any appropriate addi-
    17  tional relief.
    18    § 5. Subdivision 11 of section 460-d of the social  services  law,  as
    19  amended  by section 154 of subpart B of part C of chapter 62 of the laws
    20  of 2011, is amended to read as follows:
    21    11. On or before issuance by the department to an adult care  facility
    22  operator of official written notice of: the proposed revocation, suspen-
    23  sion  or  denial of the operator's operating certificate; the limitation
    24  of the operating certificate with respect to new admissions;  the  issu-
    25  ance of a department order or commissioner's order; the seeking of equi-
    26  table  relief pursuant to this section; the proposed assessment of civil
    27  penalties for violations of the  provisions  of  [subparagraph  two  of]
    28  paragraph [(b)] (c) of subdivision seven of this section or placement on
    29  the "do not refer list" pursuant to subdivision fifteen of this section,
    30  written  notice  also  shall  be  given to the appropriate office of the
    31  department of mental hygiene, department of  corrections  and  community
    32  supervision  and  local  social services districts, and provided further
    33  that the department of health shall notify hospitals, residential health
    34  care facilities and adult care facilities in the locality in which  such
    35  facility is located that such notice has been issued. Upon resolution of
    36  such  enforcement  action  the  department  shall notify the appropriate
    37  office of the department of mental hygiene,  department  of  corrections
    38  and community supervision, local social services districts [and], hospi-
    39  tals, residential health care facilities and adult care facilities.
    40    §  6.  Subdivision  12 of section 460-d of the social services law, as
    41  amended by section 42 of part B of chapter 58 of the laws  of  2004,  is
    42  amended to read as follows:
    43    12. [Social] Hospitals, residential health care facilities, adult care
    44  facilities,  social  services districts and other local government enti-
    45  ties established pursuant to  this  chapter  shall  be  prohibited  from
    46  making  referrals  for  admissions  to  adult  care facilities that have
    47  received official written notice  regarding:  the  proposed  revocation,
    48  suspension  or denial of the operator's operating certificate; the limi-
    49  tation of the operating certificate with respect to new admissions;  the
    50  issuance  of  department  order or commissioner's orders; the seeking of
    51  equitable relief pursuant to this section; the  proposed  assessment  of
    52  civil  penalties  for  violations of the provisions of [subparagraph two
    53  of] paragraph [(b)] (c) of subdivision seven of  this  section;  or  the
    54  facility's  placement on the "do not refer list" pursuant to subdivision
    55  fifteen of this section.

        S. 3460                             6
 
     1    § 7. Section 460-d of the social services law is amended by  adding  a
     2  new subdivision 18 to read as follows:
     3    18. When the department of health issues official written notice to an
     4  operator  of  a  proposed action specified in subdivision eleven of this
     5  section, and the department determines that there is a  condition  which
     6  constitutes  an  imminent danger to the health, safety or welfare of any
     7  resident, the department may prohibit that operator from  admitting  any
     8  new  resident to the facility until the department determines that there
     9  is no longer an imminent danger to the health, safety or welfare of  any
    10  resident.
    11    §  8.  Section 461-c of the social services law is amended by adding a
    12  new subdivision 10 to read as follows:
    13    10. The operator of an adult home or an enriched housing program shall
    14  provide to prospective residents who inquire about admission, and  shall
    15  post   on   its   website,   a   copy   of   the   facility's   approved
    16  admission/residency agreement, including the rates charged to residents.
    17    § 9. The closing paragraph of subdivision 3 of section  461-d  of  the
    18  social  services  law,  as  added by chapter 601 of the laws of 1981, is
    19  amended to read as follows:
    20    Waiver of any provision [contained within] of this  subdivision  by  a
    21  resident  of an adult care facility or by the resident's legal represen-
    22  tative or resident representative, with respect  to  a  resident  of  an
    23  adult  home,  residence for adults or enriched housing program, shall be
    24  void.
    25    § 10. Section 461-e of the social services law is amended by adding  a
    26  new subdivision 3-a to read as follows:
    27    3-a. Every adult home and enriched housing program shall:
    28    (a)  Post in a prominent position in the facility so as to be accessi-
    29  ble to all residents and to the general public, a summary of any  report
    30  of inspection based on a complaint issued by the department of health to
    31  the facility within the previous year.
    32    (b) Provide to any resident and each applicant for admission an oppor-
    33  tunity to review any report of inspection based on a complaint issued by
    34  the department of health to the facility within the previous year.
    35    § 11. Paragraphs (a), (b) and (c) of subdivision 2 of section 461-a of
    36  the  social  services  law, paragraphs (a) and (c) as amended by chapter
    37  735 of the laws of 1994 and paragraph (b) as amended by chapter  601  of
    38  the laws of 1981, are amended to read as follows:
    39    (a) With respect to adult care facilities the department shall conduct
    40  a  minimum of one unannounced inspection of each such facility to deter-
    41  mine the  adequacy of care being rendered, pursuant to the following:
    42    (1) Such facilities [receiving the department's highest rating] deter-
    43  mined by the department to be in compliance  or  substantial  compliance
    44  with  applicable  statutes and regulations, based on the facility's most
    45  recent inspection, shall be  inspected  at  least  once  every  eighteen
    46  months on an unannounced basis.
    47    (2)  All  other  such  facilities shall be inspected on an unannounced
    48  basis no less than annually.   The commissioner  may  provide  for  more
    49  frequent  inspections  of any such facilities. Such inspection shall not
    50  be required with respect to any facility for which the commissioner  has
    51  delegated  responsibility  for  inspection  and  supervision to a social
    52  services official pursuant to  section  four  hundred  sixty-c  of  this
    53  [chapter]  article.  Any employee of the department or a social services
    54  district who gives or causes to be given advance notice  of  such  unan-
    55  nounced  inspections  to  any unauthorized persons shall, in addition to
    56  any other penalty provided by law, be suspended by the department or the

        S. 3460                             7
 
     1  social services district from all duties without pay for at  least  five
     2  days  or  for  such  greater  period of time as the department or social
     3  services district shall determine.  Any such suspension shall be made by
     4  the  department or social services district in accordance with all other
     5  applicable provisions of law.
     6    (b) [The department or a social services district, where  appropriate,
     7  shall  each  year conduct a minimum of one full inspection of each adult
     8  care facility. Such inspection] An inspection of an adult care  facility
     9  under  this section shall include, but shall not be limited to, examina-
    10  tion of the medical, dietary and social services records of the facility
    11  as well as the minimum standards of construction, life safety standards,
    12  quality and adequacy of care, rights  of  residents,  payments  and  all
    13  other  areas  of  operation.  The  purpose of any inspection shall be to
    14  determine compliance with requirements of applicable provisions  of  law
    15  and regulations of the department.
    16    (c)  (i)  An  inspection report shall be made of each inspection which
    17  shall clearly identify and indicate in detail each  area  of  operation,
    18  including, but not limited to, the premises, equipment, personnel, resi-
    19  dent care and services, and whether [each] any such area of operation or
    20  any  of  its component parts is [or is] not in compliance with the regu-
    21  lations of the department and all other applicable requirements. It also
    22  shall identify those areas of operation or any of  its  component  parts
    23  found not in compliance as a result of failure in systemic practices and
    24  procedures.  The  operator  shall  be  notified  of  the  results of the
    25  inspection in a manner to be determined by regulations of the department
    26  and shall submit a written plan of correction to the  department  within
    27  thirty  calendar  days  from the date the inspection report is received.
    28  The department shall notify the operator of  the  acceptability  of  the
    29  plan  of  correction  within  thirty  calendar  days of the department's
    30  receipt of such plan.  Such notification [shall] may contain  directions
    31  as may be appropriate as to the manner and time in which compliance with
    32  applicable requirements of law or regulations of the department shall be
    33  effected.
    34    (ii)  The department shall also require the operator of an adult home,
    35  enriched housing program or residence for adults to develop,  biannually
    36  update  and  implement  plans  for quality assurance activities for each
    37  area of operation. Quality assurance  activities  include  but  are  not
    38  limited  to, development and maintenance of performance standards, meas-
    39  urement of adherence to such standards and to applicable state and local
    40  laws and regulations, identification of  performance  failures,  design,
    41  and implementation of corrective action.
    42    §  12. Subparagraphs (I) and (II) of paragraph 2 of subdivision (i) of
    43  section 29.15 of the mental hygiene law, as amended by  chapter  168  of
    44  the laws of 2010, are amended to read as follows:
    45    (I)  A patient about to be discharged or conditionally released from a
    46  department facility licensed or operated by the office for  people  with
    47  developmental  disabilities  or  from  an inpatient facility operated or
    48  licensed by the office of alcoholism and substance abuse services or the
    49  office of mental health to an adult home, enriched  housing  program  or
    50  residence  for  adults, as defined in section two of the social services
    51  law, shall be referred only to such home or residence that is consistent
    52  with that patient's needs and that operates  pursuant  to  section  four
    53  hundred sixty of the social services law, provided further that: (A) for
    54  a department facility licensed or operated by the office for people with
    55  developmental  disabilities or for an inpatient facility operated by the
    56  office of alcoholism and substance  abuse  services  or  the  office  of

        S. 3460                             8

     1  mental  health,  the  facility  director  retains authority to determine
     2  whether the home, program or residence is consistent with that patient's
     3  needs and (B) such referral shall be made to the patient's  home  county
     4  whenever possible or appropriate.
     5    (II)  No patient about to be discharged or conditionally released from
     6  a department facility licensed or operated by the office for people with
     7  developmental disabilities or from an  inpatient  facility  operated  or
     8  licensed by the office of alcoholism and substance abuse services or the
     9  office  of  mental  health shall be referred to any adult home, enriched
    10  housing program or residence for adults, as defined in  section  two  of
    11  the  social  services law, which has received an official written notice
    12  from the department of health of: (A) the proposed  revocation,  suspen-
    13  sion  or  denial of its operating certificate; (B) the limitation of its
    14  operating certificate with respect to new admissions; (C)  the  issuance
    15  of a department of health order or commissioner of health's order or the
    16  seeking  of equitable relief pursuant to section four hundred sixty-d of
    17  the social services law; (D) the proposed assessment of civil  penalties
    18  for  violations  of  the  provisions  of [subparagraph two of] paragraph
    19  [(b)] (c) of subdivision seven of section four hundred  sixty-d  of  the
    20  social services law; or placement on the "do not refer list" pursuant to
    21  subdivision  fifteen  of  section  four  hundred  sixty-d  of the social
    22  services law. Referrals may resume when  such  enforcement  actions  are
    23  resolved.
    24    § 13. Severability clause. If any provision of this act, or any appli-
    25  cation  of  any  provision  of  this  act,  is held to be invalid, or to
    26  violate or be inconsistent with any  federal  law  or  regulation,  that
    27  shall not affect the validity or effectiveness of any other provision of
    28  this  act,  which can be given effect without that provision or applica-
    29  tion; and to that end, the provisions and applications of this  act  are
    30  severable.
    31    §  14.  This act shall take effect on the ninetieth day after it shall
    32  have become a law. Effective immediately,  the  commissioner  of  health
    33  shall  make  regulations  and  take other actions necessary to implement
    34  this act on that date.
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